Provider Demographics
NPI:1821120726
Name:EMMANUEL J. BATTAH, M.D., PSC
Entity Type:Organization
Organization Name:EMMANUEL J. BATTAH, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-6133
Mailing Address - Street 1:1025 GREAT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-5107
Mailing Address - Country:US
Mailing Address - Phone:270-886-6133
Mailing Address - Fax:
Practice Address - Street 1:1025 GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-5107
Practice Address - Country:US
Practice Address - Phone:270-886-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64170947Medicaid
KY1377301Medicare ID - Type Unspecified
KYC74887Medicare UPIN