Provider Demographics
NPI:1790797702
Name:E'TOWN LUNG SPECIALIST, PSC
Entity Type:Organization
Organization Name:E'TOWN LUNG SPECIALIST, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIJAZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-735-9066
Mailing Address - Street 1:914 N DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2520
Mailing Address - Country:US
Mailing Address - Phone:270-735-9066
Mailing Address - Fax:270-735-9036
Practice Address - Street 1:914 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-735-9066
Practice Address - Fax:270-735-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328784Medicaid
290014995OtherRAILROAD MEDICARE
KY0725501Medicare PIN
KYG10744Medicare UPIN