Provider Demographics
NPI:1124125497
Name:JOSEPH C. BANIS, JR., M.D., P.S.C.
Entity type:Organization
Organization Name:JOSEPH C. BANIS, JR., M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-589-8000
Mailing Address - Street 1:2507 BUSH RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5885
Mailing Address - Country:US
Mailing Address - Phone:502-589-8000
Mailing Address - Fax:502-589-8001
Practice Address - Street 1:2507 BUSH RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5885
Practice Address - Country:US
Practice Address - Phone:502-589-8000
Practice Address - Fax:502-589-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDD3586OtherRR MCR
IN200209460AMedicaid
IN219980Medicare ID - Type UnspecifiedGROUP
KY9194Medicare ID - Type UnspecifiedGROUP
DD3586Medicare PIN