Provider Demographics
NPI:1518183821
Name:STELLAR HEALTH CARE ASSOCIATES INC.,
Entity Type:Organization
Organization Name:STELLAR HEALTH CARE ASSOCIATES INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:AVULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-563-3000
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-0399
Mailing Address - Country:US
Mailing Address - Phone:270-563-3000
Mailing Address - Fax:270-563-2801
Practice Address - Street 1:121 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171
Practice Address - Country:US
Practice Address - Phone:270-563-3000
Practice Address - Fax:270-563-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64311731Medicaid
KY9282Medicare PIN
KYG17782Medicare UPIN