Provider Demographics
NPI:1518930361
Name:M DESAI PSC
Entity Type:Organization
Organization Name:M DESAI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-2122
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:STE LL103 BLDG B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-926-2122
Mailing Address - Fax:270-684-8788
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:STE LL103 BLDG B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-926-2122
Practice Address - Fax:270-684-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32753208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64327539Medicaid
KY000000201511OtherBCBS
KY1919801Medicare ID - Type Unspecified
KY1918101Medicare ID - Type Unspecified
KY000000201511OtherBCBS
KY1891301Medicare ID - Type Unspecified