Provider Demographics
NPI:1518155639
Name:PRAKASH G. MAHALINGASHETTY, MD, PSC
Entity Type:Organization
Organization Name:PRAKASH G. MAHALINGASHETTY, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAHALINGASHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-1129
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-1129
Mailing Address - Fax:606-237-0331
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-1129
Practice Address - Fax:606-237-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20904208600000X
WV19423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7441OtherMEDICARE GROUP NUMBER
KY64209042Medicaid
WV0125873000Medicaid
WV0125873000Medicaid
F65947Medicare UPIN
KY0744101Medicare PIN
WV4044852Medicare PIN