Provider Demographics
NPI:1992978365
Name:KENTUCKIANA PAIN SPECIALISTS PSC
Entity type:Organization
Organization Name:KENTUCKIANA PAIN SPECIALISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-995-4004
Mailing Address - Street 1:PO BOX 24261
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40224-0261
Mailing Address - Country:US
Mailing Address - Phone:502-995-4004
Mailing Address - Fax:
Practice Address - Street 1:3710 CHAMBERLAIN LN STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2002
Practice Address - Country:US
Practice Address - Phone:502-995-4004
Practice Address - Fax:502-933-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0014X
KY6922560001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7891Medicare PIN