Provider Demographics
NPI:1093920480
Name:PATHAK & PATHAK, M.D., P.S.C.
Entity Type:Organization
Organization Name:PATHAK & PATHAK, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-726-8411
Mailing Address - Street 1:1527 NASHVILLE ST
Mailing Address - Street 2:P O BOX 597
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8851
Mailing Address - Country:US
Mailing Address - Phone:270-726-9811
Mailing Address - Fax:270-726-6217
Practice Address - Street 1:1527 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8851
Practice Address - Country:US
Practice Address - Phone:270-726-9811
Practice Address - Fax:270-726-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19221207VG0400X
KY19220208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64192206Medicaid
KY1008301Medicare ID - Type Unspecified
KYC69482Medicare UPIN