Provider Demographics
NPI:1841450665
Name:PHOENIX HEALTH ASSOCIATES PLLC
Entity type:Organization
Organization Name:PHOENIX HEALTH ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GHANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-737-0904
Mailing Address - Street 1:P.O. BOX 896
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-0896
Mailing Address - Country:US
Mailing Address - Phone:859-737-0904
Mailing Address - Fax:859-737-0902
Practice Address - Street 1:1021 MAJESTIC DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1492
Practice Address - Country:US
Practice Address - Phone:859-737-0904
Practice Address - Fax:859-737-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY32188251S00000X
KYKY35740251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941874Medicaid