Provider Demographics
NPI:1699066803
Name:NARAYAN VENGUSWAMY PSC
Entity type:Organization
Organization Name:NARAYAN VENGUSWAMY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENGUSWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-863-5321
Mailing Address - Street 1:1140 LEXINGTON RD # 101
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-863-5321
Mailing Address - Fax:502-863-5706
Practice Address - Street 1:1140 LEXINGTON RD # 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-863-5321
Practice Address - Fax:502-863-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY236082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64236086Medicaid
KY1399601Medicare PIN
KYC68444Medicare UPIN