Pearl Medical Practice Pllc

LBN: Pearl Medical Practice Pllc
Pearl Medical Practice Pllc is an health care organization with primary practice located at 4200 Gardiner View Ave Suite 200, Louisville KY 40213-1877. The organization recently has 5 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Ambulatory Health Care Facilities / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Ambulatory Health Care Facilities / Primary Care is the primary health care specialty. Pearl Medical Practice Pllc can be contacted via phone (502) 456-0494, or through Omoruyi, Osawaru via phone (502) 456-0494.

Contact Information

Primary practice address
4200 Gardiner View Ave Suite 200 Louisville KY 40213-1877
Phone: (502) 456-0494
Fax: (502) 456-0496
Website:
Map and Directions
Authorized official contact:
Name: Omoruyi, Osawaru Doctor of Medicine (MD)
Phone: (502) 456-0494

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X
Ambulatory Health Care Facilities / Primary Care 261QP2300X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X

Profile Details

NPI number 1114261203
LBN Legal business name Pearl Medical Practice Pllc
DBA Doing business as
Authorized official Omoruyi, Osawaru Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 15th, 2012
Last updated Oct 2nd, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114261203 NPPES
Kentucky MEDICAID 7100267920
Kentucky MEDICAID 7100259660

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