Provider Demographics
NPI:1619158987
Name:PR VELLAYAN MD PSC
Entity Type:Organization
Organization Name:PR VELLAYAN MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERIYAKARUPPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-1000
Mailing Address - Street 1:306 HOSPITAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4095
Mailing Address - Country:US
Mailing Address - Phone:606-237-1000
Mailing Address - Fax:606-237-1001
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-1000
Practice Address - Fax:606-237-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0446Medicare PIN