NPIMap

Organization Active NPI

Commonwealth of Kentucky

Doing business as Lee Specialty Clinic

  • Multi-Specialty Clinic/Center
  • Louisville, KY
National Provider Identifier
1326467986
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COMMONWEALTH OF KENTUCKY
Doing business as
Lee Specialty Clinic
Practice address
4501 Louise Underwood Way
Louisville, KY 40216-3987
Phone
(502) 363-8421
NPI assigned
Apr 10, 2014
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONWEALTH OF KENTUCKYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Moore
Title
Assistant Director
Phone
(502) 782-6117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

4501 Louise Underwood Way
Louisville, KY 40216-3987

Mailing address

4501 Louise Underwood Way
Louisville, KY 40216-3987
Phone (502) 363-8421

Other names 1

  • Lee Specialty Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150415002129 KY Part B Supplier - Clinic/Group Practice 0840180816 Receives reassigned benefits from 32 practitioners
Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Commonwealth of Kentucky126 organizations share this tax ID, including this one
Part of
Commonwealth of Kentucky

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4501 Louise Underwood Way
Louisville, KY 40216
Phone (502) 368-2348

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Central State HospitalLouisville, KY, CCN 184015 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 1992

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1326467986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 LOUISE UNDERWOOD WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402163987",
            "telephone_number": "502-363-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 LOUISE UNDERWOOD WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402163987",
            "telephone_number": "502-363-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF KENTUCKY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF KENTUCKY",
        "enumeration_date": "2014-04-10",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ASSISTANT DIRECTOR",
        "authorized_official_telephone_number": "502-782-6117"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lee Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lee Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.