Provider Demographics
NPI:1578719118
Name:AMELIA R KISER MD PSC
Entity Type:Organization
Organization Name:AMELIA R KISER MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-1221
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0430
Mailing Address - Country:US
Mailing Address - Phone:270-651-1221
Mailing Address - Fax:
Practice Address - Street 1:218 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2932
Practice Address - Country:US
Practice Address - Phone:270-651-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH02537Medicare UPIN
KY1803001Medicare PIN
KY64332505Medicare PIN