Provider Demographics
NPI:1467457945
Name:VANSAVAGE, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:VANSAVAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIRCLE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-251-4060
Mailing Address - Fax:270-251-4061
Practice Address - Street 1:1029 MEDICAL CENTER CIR STE 408
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1189
Practice Address - Country:US
Practice Address - Phone:270-251-4060
Practice Address - Fax:270-251-4061
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14153R208800000X
KY32546208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA340019044OtherRAILROAD MEDICARE
LA1189413Medicaid
LA340019044OtherRAILROAD MEDICARE
LA4A241Medicare PIN