Provider Demographics
NPI:1821270307
Name:SANGEETA RAHUL PATIL MD PSC
Entity Type:Organization
Organization Name:SANGEETA RAHUL PATIL MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETA
Authorized Official - Middle Name:RAHUL
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-9769
Mailing Address - Street 1:1200 CENTRAL AVE
Mailing Address - Street 2:STE. 2
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7575
Mailing Address - Country:US
Mailing Address - Phone:606-325-9769
Mailing Address - Fax:606-329-3901
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:STE. 2
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7575
Practice Address - Country:US
Practice Address - Phone:606-325-9769
Practice Address - Fax:606-329-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64347024Medicaid
KY64347024Medicaid
KYG91193Medicare UPIN