1518155639 NPI number — PRAKASH G. MAHALINGASHETTY, MD, PSC

Table of content: (NPI 1518155639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518155639 NPI number — PRAKASH G. MAHALINGASHETTY, MD, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAKASH G. MAHALINGASHETTY, 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:
1518155639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SOUTH WILLIAMSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41503-4095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-237-1129
Provider Business Mailing Address Fax Number:
606-237-0331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SOUTH WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503-4095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-1129
Provider Business Practice Location Address Fax Number:
606-237-0331
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAHALINGASHETTY
Authorized Official First Name:
PRAKASH
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
606-237-1129

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  20904 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 19423 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7441 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64209042 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0125873000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com