Provider Demographics
NPI:1821109810
Name:EAST KY PULMONARY & ASSOCIATES
Entity Type:Organization
Organization Name:EAST KY PULMONARY & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMANARAO
Authorized Official - Middle Name:V
Authorized Official - Last Name:METTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-437-4925
Mailing Address - Street 1:387 TOWN MOUNTAIN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1640
Mailing Address - Country:US
Mailing Address - Phone:606-437-4925
Mailing Address - Fax:606-437-4930
Practice Address - Street 1:387 TOWN MOUNTAIN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1640
Practice Address - Country:US
Practice Address - Phone:606-437-4925
Practice Address - Fax:606-437-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240108000Medicaid
KY65905481Medicaid
KY65905481Medicaid