NPIMap

Organization Active NPI

Park Duvalle Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Louisville, KY
National Provider Identifier
1497625263
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Practice address
3628 Virginia Ave
Louisville, KY 40211-1664
Phone
(502) 774-4401
Fax
(502) 618-1213
NPI assigned
Nov 7, 2025
Organization subpart
Yes
Parent organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Dr. Swannie Jett
Title
Ceo
Phone
(502) 774-4401

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 51

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302000539 KY Part B Supplier - Clinic/Group Practice 1658268974 Receives reassigned benefits from 32 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eminence, KY; Louisville, KY; Taylorsville, KY
O20141204001974 KY Part B Supplier - Mass Immunization (Roster Biller Only) 1658268974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Louisville, KY

National Provider Directory

National Provider Directory
Tax ID family
Park Duvalle Community Health Center Inc9 organizations share this tax ID, including this one
Part of
Park Duvalle Community Health Center Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 W Broadway St
Eminence, KY 40019
Phone (502) 772-5034

3628 Virginia Ave
Louisville, KY 40211
Phone (502) 774-4401

1425 W Broadway
Louisville, KY 40203
Phone (502) 245-0002

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

3628 Virginia Ave
Louisville, KY 40211-1664

Mailing address

3628 Virginia Ave
Louisville, KY 40211-1664
Phone (502) 774-4401

Other names 1

NPPES NPI Registry
  • Park DuValle at West End School Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 6, 2026.

{
    "created_epoch": "1762473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1497625263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3628 VIRGINIA AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111664",
            "telephone_number": "502-774-4401",
            "fax_number": "502-618-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3628 VIRGINIA AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111664",
            "telephone_number": "502-774-4401",
            "fax_number": "502-618-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DUVALLE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK DUVALLE COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2025-11-07",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "JETT",
        "authorized_official_first_name": "SWANNIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-774-4401",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park DuValle at West End School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.