NPIMap

Organization Active NPI

Park Duvalle Community Health Center, Inc

  • Clinic Pharmacy
  • Louisville, KY
National Provider Identifier
1578286985
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Practice address
3828 Bardstown Rd
Louisville, KY 40218-1527
Phone
(502) 479-8930
NPI assigned
Sep 21, 2022
Organization subpart
Yes
Parent organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Swannie Jett
Title
Ceo
Phone
(502) 774-4401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

3828 Bardstown Rd
Louisville, KY 40218-1527

Mailing address

3015 Wilson Ave
Louisville, KY 40211-1969
Phone (502) 774-4401

Other identifiers 2

IdentifierTypeStateIssuer
P08243OtherKYPHARMACY LIC
31000011MedicaidKY

Other names 1

  • Park Duvalle Newburg Community Pharmacy Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1578286985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 WILSON AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111969",
            "telephone_number": "502-774-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 BARDSTOWN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402181527",
            "telephone_number": "502-479-8930"
        }
    ],
    "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": "2022-09-21",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "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"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LIC",
            "identifier": "P08243",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31000011",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Duvalle Newburg Community Pharmacy",
            "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 Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.