Provider Demographics
NPI:1194826735
Name:APPALACHIAN CARDIOLOGY CLINIC, PSC
Entity Type:Organization
Organization Name:APPALACHIAN CARDIOLOGY CLINIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAHMAJI
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC, FSCAI
Authorized Official - Phone:606-432-6162
Mailing Address - Street 1:PO BOX 2197
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2197
Mailing Address - Country:US
Mailing Address - Phone:606-432-6162
Mailing Address - Fax:606-432-6142
Practice Address - Street 1:419 TOWN MOUNTAIN RD STE 202
Practice Address - Street 2:PROFESSIONAL ASSOCIATES BLDG
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1633
Practice Address - Country:US
Practice Address - Phone:606-432-6162
Practice Address - Fax:606-432-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65924698Medicaid
KYF48016Medicare UPIN
KY65924698Medicaid