Provider Demographics
NPI:1205823721
Name:ASHLAND GASTROENTEROLOGY PSC
Entity Type:Organization
Organization Name:ASHLAND GASTROENTEROLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJKUMAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-9644
Mailing Address - Street 1:300 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7020
Mailing Address - Country:US
Mailing Address - Phone:606-836-9644
Mailing Address - Fax:606-836-6276
Practice Address - Street 1:300 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7020
Practice Address - Country:US
Practice Address - Phone:606-836-9644
Practice Address - Fax:606-836-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64205388Medicaid
KY1300201Medicare PIN