Provider Demographics
NPI:1184984700
Name:NS PANWAR, MD, PC
Entity type:Organization
Organization Name:NS PANWAR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-237-9900
Mailing Address - Street 1:414 CENTRAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4121
Mailing Address - Country:US
Mailing Address - Phone:606-237-9900
Mailing Address - Fax:606-237-9901
Practice Address - Street 1:414 CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4121
Practice Address - Country:US
Practice Address - Phone:606-237-9900
Practice Address - Fax:606-237-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092976000Medicaid
KY64940067Medicaid
KY64940067Medicaid
KY1705701Medicare PIN