Provider Demographics
NPI:1821211996
Name:HAZARD INTERNAL MEDICINE, P.S.C
Entity Type:Organization
Organization Name:HAZARD INTERNAL MEDICINE, P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, HAZARD INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARELIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:606-438-9937
Mailing Address - Street 1:243 ROY CAMPBELL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9485
Mailing Address - Country:US
Mailing Address - Phone:606-438-9937
Mailing Address - Fax:606-487-0396
Practice Address - Street 1:243 ROY CAMPBELL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9485
Practice Address - Country:US
Practice Address - Phone:606-438-9937
Practice Address - Fax:606-487-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9698Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER