1346351319 NPI number — R.V. METTU,M.D PSC

Table of content: (NPI 1346351319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346351319 NPI number — R.V. METTU,M.D PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R.V. METTU,M.D 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:
1346351319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
387 TOWN MOUNTAIN RD
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41501-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-437-4925
Provider Business Mailing Address Fax Number:
606-437-4930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
387 TOWN MOUNTAIN RD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-437-4925
Provider Business Practice Location Address Fax Number:
606-437-4930
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
METTU
Authorized Official First Name:
RAMANARAO
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-437-7662

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , 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: 016046300 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0219334001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010039363 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6277638 . This is a "UMWA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64219561 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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