Healthcare Provider Details

I. General information

NPI: 1679619811
Provider Name (Legal Business Name): PHYSICIAN MANAGEMENT SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 HWY 259N
BROWNSVILLE KY
42210
US

IV. Provider business mailing address

PO BOX 90039
BOWLING GREEN KY
42102-9039
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2168
  • Fax: 270-597-2033
Mailing address:
  • Phone: 270-796-8800
  • Fax: 270-796-9328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900024
License Number StateKY

VIII. Authorized Official

Name: KALIDAS G SAHETYA
Title or Position: SECRETARY
Credential: MD
Phone: 270-796-8800