| Organization Name: | SOUTH OLDHAM MEDICAL CLINIC PSC |
| NPI Number: | 1922142983 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ASHOR ALUR (PHYSICIAN OWNER) |
| Mailing Address: | 6520 W Hwy 22 Crestwood |
| State: | KY US |
| Postal Code: | 40014 |
| Phone Number: | 5022418488 |
| Fax Number: | 5022417424 |
| NPI Enumeration Date: | 02/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 30373 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |