1962462382 NPI number — PHYSICIAN MANAGEMENT SERVICES PSC

Table of content: (NPI 1962462382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962462382 NPI number — PHYSICIAN MANAGEMENT SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN MANAGEMENT SERVICES 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:
ASSOCIATES IN PHYSICIANS SERVICES
Provider Other Organization Name Type Code:
3
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:
1962462382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42102-9039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-796-8800
Provider Business Mailing Address Fax Number:
270-796-9328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 US 31W BYP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-796-8800
Provider Business Practice Location Address Fax Number:
270-796-9328
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAHETYA
Authorized Official First Name:
KALIDAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
270-796-8800

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65930562 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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