Provider Demographics
NPI:1245252758
Name:WELCH, SAMUEL GEORGE (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GEORGE
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:300 FOXGLOVE DRIVE
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:606-498-2135
Practice Address - Fax:606-498-7547
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY310982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000192179OtherANTHEM BCBS
610661987039OtherMS BCBS
10988OtherCHA
2791359OtherMANAGED HEALTH
KY30610026Medicaid
1982615043OtherGROUP NPI#
0520107Medicare PIN
0519804Medicare PIN
0519210Medicare PIN
610661987039OtherMS BCBS
1982615043OtherGROUP NPI#
KY30610026Medicaid