Provider Demographics
NPI:1497776397
Name:MEDICAL SPECIALISTS OF KENTUCKIANA PLLC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF KENTUCKIANA PLLC
Other - Org Name:PAINCARE INSTITUTE DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANI
Authorized Official - Middle Name:
Authorized Official - Last Name:NADAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-896-6166
Mailing Address - Street 1:1013 DUPONT SQUARE NORTH
Mailing Address - Street 2:STE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-896-6166
Mailing Address - Fax:502-896-6168
Practice Address - Street 1:1013 DUPONT SQUARE NORTH
Practice Address - Street 2:STE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-896-6166
Practice Address - Fax:502-896-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35843207LP2900X
KY36216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64032923Medicaid
KY64042831Medicaid
KY0985802Medicare ID - Type Unspecified
KY64042831Medicaid
KYH40180Medicare UPIN
KY0985801Medicare ID - Type Unspecified