Healthcare Provider Details

I. General information

NPI: 1841450665
Provider Name (Legal Business Name): PHOENIX HEALTH ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MAJESTIC DRIVE SUITE 100
LEXINGTON KY
40513-1492
US

IV. Provider business mailing address

P.O. BOX 896
WINCHESTER KY
40392-0896
US

V. Phone/Fax

Practice location:
  • Phone: 859-737-0904
  • Fax: 859-737-0902
Mailing address:
  • Phone: 859-737-0904
  • Fax: 859-737-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberKY32188
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberKY35740
License Number StateKY

VIII. Authorized Official

Name: MR. RAMESH L GHANTA
Title or Position: OWNER
Credential: M.D.
Phone: 859-737-0904