1245318120 NPI number — SUVAS G DESAI MD PSC

Table of content: (NPI 1245318120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245318120 NPI number — SUVAS G DESAI MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUVAS G DESAI MD PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245318120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEREA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40403-0424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-985-8100
Provider Business Mailing Address Fax Number:
859-985-8300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 PAINT LICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40403-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-985-8100
Provider Business Practice Location Address Fax Number:
859-985-8300
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
SUVAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
859-985-8100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  16723 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65095440 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7182179 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000045887 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1800196 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1144216318 . This is a "NPI INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64167232 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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