Provider Demographics
| NPI: | 1487648200 |
|---|---|
| Name: | THE MEDICAL SPECIALISTS OF KY, PSC |
| Entity type: | Organization |
| Organization Name: | THE MEDICAL SPECIALISTS OF KY, PSC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO, MANAGING PARTNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SATYABRATA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHATTERJEE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 606-864-4040 |
| Mailing Address - Street 1: | 1210 W 5TH ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LONDON |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40741-2112 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 606-864-4040 |
| Mailing Address - Fax: | 606-864-3500 |
| Practice Address - Street 1: | 1210 W 5TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | LONDON |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40741-2112 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 606-864-4040 |
| Practice Address - Fax: | 606-864-3500 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-09-08 |
| Last Update Date: | 2008-04-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 209345 | Other | FEDERAL BLACK LUNG NUMBER |
| KY | 65925935 | Medicaid | |
| KY | 7840 | Medicare PIN | |
| KY | 5796 | Medicare PIN | |
| KY | 6898 | Medicare PIN | |
| KY | 65925935 | Medicaid | |
| KY | 7704 | Medicare PIN | |
| KY | 209345 | Other | FEDERAL BLACK LUNG NUMBER |
| KY | 7687 | Medicare PIN | |
| KY | CA5576 | Medicare PIN | |
| KY | 9369 | Medicare PIN | |
| KY | 9655 | Medicare PIN | |
| KY | 7268 | Medicare PIN | |
| KY | 9136 | Medicare PIN | |
| KY | 9308 | Medicare PIN | |
| KY | 9385 | Medicare PIN | |
| KY | 3058 | Medicare PIN | |
| KY | 7686 | Medicare PIN | |
| KY | 00035 | Medicare PIN |