Provider Demographics
NPI:1225200462
Name:LIANEKHAMMY, PHONESAVANE (MD)
Entity type:Individual
Prefix:DR
First Name:PHONESAVANE
Middle Name:
Last Name:LIANEKHAMMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:3118 EAST 10TH STREET
Practice Address - Street 2:NORTON COMMUNITY MEDICAL ASSOCIATES
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-282-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP138207R00000X
IN99033592A207R00000X
TNBU6476407R519207R00000X
TNMD0000043766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00533076OtherMEDICARE IN- CMA
KY200918490OtherCARE SELECT- NORTON COMMUNITY MEDICAL ASSOCIATES
KY3525703OtherCIGNA- NORTON COMMUNITY MEDICAL ASSOCIATES
INP00783046OtherRAILROAD MEDICARE- NORTON COMMUNITY MEDICAL ASSOCIATES
KY000023034HOtherHUMANA- NORTON COMMUNITY MEDICAL ASSOCIATES
KY098947OtherSIHO- NORTON COMMUNITY MEDICAL ASSOCIATES
KY200918490OtherHEALTHY INDIANA PLAN- NORTON COMMUNITY MEDICAL ASSOCIATES
KY000000586612OtherANTHEM- NORTON COMMUNITY MEDICAL ASSOCIATES
KY000000586939OtherANTHEM INDIANA MEDICAID- NORTON COMMUNITY MEDICAL ASSOCIATES
IN200918490OtherMEDICAID- NORTON CMA
KY7100070980OtherMEDICAID KY- NORTON COMMUNITY MEDICAL ASSOCIATES
IN196290BBBBOtherMEDICARE- NORTON ICC & CMA