Momology Maternal Wellness Club

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MOMOLOGY MATERNAL WELLNESS CLUB

Practice address

4614 Dohn Rd
Louisville, KY 40216-2902

Phone

(502) 354-8424

Fax

(502) 632-1432

NPI assigned

Dec 16, 2020

Organization subpart

No

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

Authorized official

Name

Jacqueline Sanders

Title

Credentialing Administrator

Phone

(502) 630-2036

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1629664313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4614 DOHN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402162902",
            "telephone_number": "502-354-8424",
            "fax_number": "502-632-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4614 DOHN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402162902",
            "telephone_number": "502-354-8424",
            "fax_number": "502-632-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMOLOGY MATERNAL WELLNESS CLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "502-630-2036"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "momologymwclub@gmail.com",
            "affiliation": "N",
            "address_1": "4614 Dohn Rd",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402162902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community/Behavioral Health Agency in Louisville, KY
• Providers in Louisville, KY by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.