Provider Demographics
NPI:1669594487
Name:MEDICAL SPECIALISTS OF KENTUCKIANA
Entity type:Organization
Organization Name:MEDICAL SPECIALISTS OF KENTUCKIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NADAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-896-6166
Mailing Address - Street 1:1013 DUPONT SQUARE NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-896-6166
Mailing Address - Fax:502-896-6168
Practice Address - Street 1:2816 VEACH ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-684-7179
Practice Address - Fax:270-684-5829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL SPECIALISTS OF KENTUCKIANA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2009-06-04
Deactivation Date:2009-04-08
Deactivation Code:
Reactivation Date:2009-06-04
Provider Licenses
StateLicense IDTaxonomies
KY35843207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64032923Medicaid
KY9858Medicare PIN
H40180Medicare UPIN
KY64032923Medicaid
0985802Medicare PIN