Provider Demographics
NPI:1285900035
Name:S. RAZA, M.D., PSC
Entity type:Organization
Organization Name:S. RAZA, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:MOHSIN
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-573-8320
Mailing Address - Street 1:110 PROFESSIONAL LN
Mailing Address - Street 2:STE 202
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2590
Mailing Address - Country:US
Mailing Address - Phone:606-573-8320
Mailing Address - Fax:606-573-8321
Practice Address - Street 1:110 PROFESSIONAL LN
Practice Address - Street 2:STE 202
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2590
Practice Address - Country:US
Practice Address - Phone:606-573-8320
Practice Address - Fax:606-573-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36481261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64027675Medicaid
KY64027675Medicaid