Provider Demographics
NPI:1558419978
Name:PADUCAH PSYCHIATRY GROUP PSC
Entity Type:Organization
Organization Name:PADUCAH PSYCHIATRY GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-443-8195
Mailing Address - Street 1:100 FOUNTAIN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-2774
Mailing Address - Country:US
Mailing Address - Phone:270-443-8195
Mailing Address - Fax:270-444-7922
Practice Address - Street 1:100 FOUNTAIN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-2774
Practice Address - Country:US
Practice Address - Phone:270-443-8195
Practice Address - Fax:270-444-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY206712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00511500OtherMAGELLAN
KY000000049057OtherBCBS
KY64206717Medicaid
KY64206717Medicaid
KY000000049057OtherBCBS
1296301Medicare ID - Type Unspecified