Healthcare Provider Details

I. General information

NPI: 1336230820
Provider Name (Legal Business Name): PAIN MANAGEMENT KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE SUITE 409
LOUISVILLE KY
40215-1190
US

IV. Provider business mailing address

4402 CHURCHMAN AVE SUITE 409
LOUISVILLE KY
40215-1190
US

V. Phone/Fax

Practice location:
  • Phone: 502-366-7318
  • Fax:
Mailing address:
  • Phone: 502-366-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KUNNATHU P. GEEVARGHESE
Title or Position: M.D.
Credential: M.D
Phone: 502-366-7317