Provider Demographics
NPI:1386849206
Name:JAYALAKSHMI PAMPATI MD PSC
Entity Type:Organization
Organization Name:JAYALAKSHMI PAMPATI MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYALAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-439-2662
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0697
Mailing Address - Country:US
Mailing Address - Phone:606-439-2662
Mailing Address - Fax:606-439-0612
Practice Address - Street 1:1908 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2505
Practice Address - Country:US
Practice Address - Phone:606-439-2662
Practice Address - Fax:606-439-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936015Medicaid
KY65936015Medicaid
KY6959Medicare PIN