Provider Demographics
NPI:1164638953
Name:KANTA ARYA MD PSC
Entity Type:Organization
Organization Name:KANTA ARYA MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-439-1815
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3L
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-139-1815
Mailing Address - Fax:606-436-5021
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3L
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-139-1815
Practice Address - Fax:606-436-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65937260Medicaid
KY000000001603OtherCHA HEALTH
KY000000041977OtherANTHEM
KY000000001603OtherCHA HEALTH