Provider Demographics
NPI:1134322670
Name:KOSCIENSKI & FOSTER PSC
Entity Type:Organization
Organization Name:KOSCIENSKI & FOSTER PSC
Other - Org Name:ROLLING HILLS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOSCIENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-340-8825
Mailing Address - Street 1:1293 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1945
Mailing Address - Country:US
Mailing Address - Phone:606-340-8825
Mailing Address - Fax:606-340-0097
Practice Address - Street 1:1293 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1945
Practice Address - Country:US
Practice Address - Phone:606-340-8825
Practice Address - Fax:606-340-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935819Medicaid
KY6874Medicare ID - Type Unspecified