Basic Information
| Provider Information | |||||||||
| NPI: | 1750422069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTER | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 9880 ANGIES WAY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946341 | ||||||||
| FaxNumber: | 5023946340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 42798 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 106460 | 01 | KY | SIHO - NOTC | OTHER | 200958310 | 05 | IN | MEDICAID | 000023036R | 01 | KY | HUMANA - NOTC | OTHER | 00533152 | 01 | KY | MEDICARE - KY - NOTC | OTHER | 7100078110 | 05 | KY | MEDICAID | 1750422069 | 05 | VA | MEDICAID | 000000624609 | 01 | KY | ANTHEM - NOTC | OTHER | 50025281 | 01 | KY | PASSPORT - NOTC | OTHER |