Provider Demographics
NPI:1720176522
Name:HEMATOLOGY ONCOLOGY PHYSICIANS EAST KENTUCKY PSC
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY PHYSICIANS EAST KENTUCKY PSC
Other - Org Name:HOPE KY PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISAHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVASUBRAMANIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-344-2444
Mailing Address - Street 1:73 THOMPSON POYNTER ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741
Mailing Address - Country:US
Mailing Address - Phone:606-344-2444
Mailing Address - Fax:606-862-4899
Practice Address - Street 1:2737 NORTH LAUREL ROAD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741
Practice Address - Country:US
Practice Address - Phone:606-843-2783
Practice Address - Fax:606-862-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38197207RH0003X, 207RX0202X
KY40196208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942567Medicaid
KYDD1704Medicare PIN
KY9481Medicare PIN