NPIMap

Organization Active NPI

Pediatric Hematology/Oncology Specialists, PSC

  • Clinical Child & Adolescent Psychologist
  • Louisville, KY
National Provider Identifier
1972827707
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
1505 Issued in KY
Legal business name
PEDIATRIC HEMATOLOGY/ONCOLOGY SPECIALISTS, PSC
Practice address
601 S Floyd St
Suite 403
Louisville, KY 40202-1835
Phone
(502) 629-7751
Fax
(500) 629-5780
NPI assigned
Mar 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

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

Authorized official

Name
Dr. Salvatore J Bertolone Jr., MD
Title
President
Phone
(502) 629-7751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X 1505 KY Primary

Addresses

Primary practice location

601 S Floyd St
Suite 403
Louisville, KY 40202-1835

Mailing address

601 S Floyd St
Suite 403
Louisville, KY 40202-1835
Phone (502) 629-7751

Other identifiers 1

IdentifierTypeStateIssuer
7100096690MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Hematology-Oncology Specialists PSC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1269302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269302400000",
    "number": "1972827707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S FLOYD ST",
            "address_2": "SUITE 403",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021835",
            "telephone_number": "502-629-7751",
            "fax_number": "500-629-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S FLOYD ST",
            "address_2": "SUITE 403",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021835",
            "telephone_number": "502-629-7751",
            "fax_number": "500-629-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEMATOLOGY/ONCOLOGY SPECIALISTS, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-23",
        "last_updated": "2010-03-23",
        "status": "A",
        "authorized_official_last_name": "BERTOLONE",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-629-7751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KY",
            "license": "1505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100096690",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 23, 2010; 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.