Provider Demographics
NPI:1083940076
Name:OSIAS M VILLAFLOR, MD, PSC
Entity Type:Organization
Organization Name:OSIAS M VILLAFLOR, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSIAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLAFLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-289-2651
Mailing Address - Street 1:2300 CONCRETE RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-9721
Mailing Address - Country:US
Mailing Address - Phone:859-289-2651
Mailing Address - Fax:859-289-2351
Practice Address - Street 1:2300 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9721
Practice Address - Country:US
Practice Address - Phone:859-289-2651
Practice Address - Fax:859-289-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21730208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64217300Medicaid