Provider Demographics
NPI:1962462382
Name:PHYSICIAN MANAGEMENT SERVICES PSC
Entity Type:Organization
Organization Name:PHYSICIAN MANAGEMENT SERVICES PSC
Other - Org Name:ASSOCIATES IN PHYSICIANS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KALIDAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAHETYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-796-8800
Mailing Address - Street 1:PO BOX 90039
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-9039
Mailing Address - Country:US
Mailing Address - Phone:270-796-8800
Mailing Address - Fax:270-796-9328
Practice Address - Street 1:427 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1703
Practice Address - Country:US
Practice Address - Phone:270-796-8800
Practice Address - Fax:270-796-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65930562Medicaid
KY5462Medicare PIN
KYC16586Medicare PIN