Provider Demographics
NPI:1013196898
Name:C KRISHNASWAMY MD PSC
Entity Type:Organization
Organization Name:C KRISHNASWAMY MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRASHEKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-7955
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0120
Mailing Address - Country:US
Mailing Address - Phone:606-487-7955
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3P
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-487-7955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY374302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64054380Medicaid
KY000000373082OtherANTHEM BLUE CROSS
KY64054380Medicaid
KYH69542Medicare UPIN