Provider Demographics
NPI:1700960200
Name:KPS SUITES, LLC
Entity Type:Organization
Organization Name:KPS SUITES, LLC
Other - Org Name:K.S.A. HOLDINGS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
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 24321
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40224-0321
Mailing Address - Country:US
Mailing Address - Phone:502-995-4004
Mailing Address - Fax:
Practice Address - Street 1:2831 S HURSTBOURNE PKWY
Practice Address - Street 2:STE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4112
Practice Address - Country:US
Practice Address - Phone:502-995-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain