Provider Demographics
NPI:1740204353
Name:HA THANH LE MD PSC
Entity Type:Organization
Organization Name:HA THANH LE MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-765-6149
Mailing Address - Street 1:914 N DIXIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2536
Mailing Address - Country:US
Mailing Address - Phone:270-765-6149
Mailing Address - Fax:270-737-5235
Practice Address - Street 1:914 N DIXIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2536
Practice Address - Country:US
Practice Address - Phone:270-765-6149
Practice Address - Fax:270-737-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18501174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65939274Medicaid
KY000000047264OtherANTHEM BCBS
KY000000047264OtherANTHEM BCBS
KY1170201Medicare ID - Type Unspecified