Provider Demographics
NPI:1295311058
Name:KENTUCKIANA PAIN SPECIALISTS PSC
Entity type:Organization
Organization Name:KENTUCKIANA PAIN SPECIALISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AJITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-995-4004
Mailing Address - Street 1:PO BOX 24261
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40224-0261
Mailing Address - Country:US
Mailing Address - Phone:502-299-4004
Mailing Address - Fax:502-933-5559
Practice Address - Street 1:3710 CHAMBERLAIN LN STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2002
Practice Address - Country:US
Practice Address - Phone:502-995-4004
Practice Address - Fax:502-933-5559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKIANA PAIN SPECIALISTS PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3336H0001XSuppliersPharmacyHome Infusion Therapy PharmacyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100495680Medicaid