Individual ProviderPaul DavisInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831(502) 629-5552(502) 588-9490PECOS EnrollmentBased on the most recent information from CMS, provider Paul Davis is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1114381043Provider TypeIndividualFull NameDavis, PaulTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date4/6/2016Last Updated2/8/2023Contact InformationPractice LocationPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831Phone(502) 629-5552Fax(502) 629-3132Mailing LocationMailing AddressPO Box 776351, Chicago, IL 60677-6351Phone(502) 588-9490Fax(502) 272-5116Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense52475KentuckyCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDK289220DescriptionOtherIssuerMEDICAREKentuckyID300028715DescriptionMedicaidIssuerUnlistedIndianaID7100609260DescriptionMedicaidIssuerUnlistedKentucky