Healthcare Provider Details

I. General information

NPI: 1295311058
Provider Name (Legal Business Name): KENTUCKIANA PAIN SPECIALISTS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 CHAMBERLAIN LN STE A
LOUISVILLE KY
40241-2002
US

IV. Provider business mailing address

PO BOX 24261
LOUISVILLE KY
40224-0261
US

V. Phone/Fax

Practice location:
  • Phone: 502-995-4004
  • Fax: 502-933-5559
Mailing address:
  • Phone: 502-299-4004
  • Fax: 502-933-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: AJITH NAIR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 502-995-4004