PARK DUVALLE AT NEWBURG
NPI 1780698506
Clinic/Center - Federally Qualified Health Center (FQHC) in Louisville, KY

Q: What is Park Duvalle Community Health Center, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since July 28, 2006CLIA 18D1035439 · Waiver

3828 BARDSTOWN RD, LOUISVILLE, KY 40218(502) 479-8930 Get Directions Write a Review

NPPES record last updated: November 11, 2022. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Nov 11, 2022, Nov 2, 2021, Dec 19, 2016 (3 updates tracked since 2016).

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About Park Duvalle At Newburg NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK DUVALLE AT NEWBURG (NPI 1780698506) is a healthcare organization registered as a federally qualified health center (fqhc) in Louisville, Kentucky and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 20, 2027, maintains a secondary practice location in Louisville, and lists Swannie Jett, Ceo, as its authorized official.

NPPES Registry Identity

NPI1780698506

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NamePARK DUVALLE COMMUNITY HEALTH CENTER, INC

Location Address3828 BARDSTOWN RDLouisville, KY 40218-1527

Mailing Address3015 Wilson AveLouisville, KY 40211-1969 · (502) 774-4401 · Fax (502) 772-4783

Phone(502) 479-8930

Organization SubpartNo

Authorized OfficialSwannie JettCeo · (502) 774-4401

Enumeration DateJuly 28, 2006

Last NPPES UpdateNovember 11, 20223 updates tracked since enumeration

NPPES CertifiedNovember 11, 2022

✔ NPI 1780698506 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

License✔ Licensed in KY · 700005

3828 BARDSTOWN RD, Louisville, KY 40218

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Other Names 1

Other NamePark Duvalle At Newburg

Secondary Practice Location 1

Location 12237 Hikes LnLouisville, KY 40218-2203 · Phone (502) 479-8930 · Fax (502) 479-8934

Other Identifiers 1

Medicaid31000011KY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Home State Health, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 18D1035439

Park Duvalle At Newburg · Louisville, KY

Active · expires Aug 20, 2027

CLIA Number18D1035439

Laboratory TypeCommunity Clinic

Certificate Effective DateAugust 21, 2025

Certificate Expiration DateAugust 20, 2027

Laboratory DirectorDr. Mohammad Faghri

Laboratory Phone(502) 479-8930

Laboratory LocationPark Duvalle At Newburg3828 Bardstown, Louisville, KY 40218

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SASSER,DAVIS & IGLEHART

Family Medicine