RUSSELL NEIGHBOROOD HEALTH CENTER – NPI #1255354361
Clinic/Center

RUSSELL NEIGHBOROOD HEALTH CENTER is an AHC clinic located in LOUISVILLE, KY. NPPES has assigned the NPI number 1255354361 to RUSSELL NEIGHBOROOD HEALTH CENTER on July 26, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “RUSSELL NEIGHBOROOD HEALTH CENTER” is a dba name, the actual legal business name for this organization is PARK DUVALLE COMMUNITY HEALTH CENTER, INC.. The primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 5 years ago on Nov 02, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for RUSSELL NEIGHBOROOD HEALTH CENTER below.

NPI Profile for
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.

NPI Number
1255354361
Enumeration Date

(about 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Doing Business As (dba): RUSSELL NEIGHBOROOD HEALTH CENTER
Primary location
1425 W. BROADWAY
LOUISVILLE, KY 40202
Phone: (502) 584-2992 Fax: (502) 584-3715
Mailing address
3015 WILSON AVE
LOUISVILLE, KY 40211-1969
Phone: (502) 774-4401 Fax: (502) 772-4783
Organization Subpart
Yes - RUSSELL NEIGHBOROOD HEALTH CENTER is subpart of another organization.
Authorized Official
SWANNIE JETT
CEO
Phone: (502) 774-4401
Updated
Certification Date
Nov 02, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for RUSSELL NEIGHBOROOD HEALTH CENTER

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDKY31000011
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)		 KY 700005

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.