Provider Demographics
NPI:1205975554
Name:AHSEN ALI MD PSC
Entity type:Organization
Organization Name:AHSEN ALI MD PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHSEN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-4800
Mailing Address - Street 1:160 HOSPITAL DR
Mailing Address - Street 2:ARH HOSPITAL
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4071
Mailing Address - Country:US
Mailing Address - Phone:606-237-4800
Mailing Address - Fax:606-237-4803
Practice Address - Street 1:306 HOSPITAL DR STE 2C
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-4800
Practice Address - Fax:606-237-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 261QR1300X, 363LF0000X
KY31875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
207518OtherCARELINK
WV002038132003OtherUNITED HEALTH CARE
KY002038132004OtherUNITED HEALTH CARE
3519OtherCHA HEALTH INS
KY64318751Medicaid
9586OtherBLUEGRASS FAMILY
5996190OtherAETNA
202554OtherBLACK LUNG
137177OtherUMWA
113278OtherCHA
387156OtherMAMSI
137177OtherUMWA
KYG21608Medicare UPIN
3519OtherCHA HEALTH INS
113278OtherCHA
KY64318751Medicaid