Provider Demographics
NPI:1326243916
Name:CHARLES S. GILES MD, PSC
Entity Type:Organization
Organization Name:CHARLES S. GILES MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-384-6451
Mailing Address - Street 1:3066 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9511
Mailing Address - Country:US
Mailing Address - Phone:270-384-6451
Mailing Address - Fax:270-384-9100
Practice Address - Street 1:3066 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9511
Practice Address - Country:US
Practice Address - Phone:270-384-6451
Practice Address - Fax:270-384-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207R00000X, 363L00000X
KY0266103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932634 PHYMedicaid
KY7100305610 NPMedicaid
KY5893Medicare PIN