Provider Demographics
NPI:1871559286
Name:U OF L RESEARCH FOUNDATION
Entity type:Organization
Organization Name:U OF L RESEARCH FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF DEPT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-852-5498
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-562-6810
Mailing Address - Fax:502-562-6777
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208
Practice Address - Country:US
Practice Address - Phone:502-637-9313
Practice Address - Fax:502-635-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6312Medicare ID - Type Unspecified