Provider Demographics
NPI:1962416842
Name:WESTERN KENTUCKY PULMONARY CLINIC
Entity type:Organization
Organization Name:WESTERN KENTUCKY PULMONARY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAJMUDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-8840
Mailing Address - Street 1:1724 KENTON ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1981
Mailing Address - Country:US
Mailing Address - Phone:270-886-8840
Mailing Address - Fax:270-886-8869
Practice Address - Street 1:1724 KENTON ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1981
Practice Address - Country:US
Practice Address - Phone:270-886-8840
Practice Address - Fax:270-886-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936122Medicaid
KY000000208318OtherBCBS
KY65936122Medicaid