Healthcare Provider Details

I. General information

NPI: 1225145444
Provider Name (Legal Business Name): PHYSICIANS FOR CHILDREN & ADOLESCENTS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SOUTH MAYO TRAIL, SUITE 201
PIKEVILLE KY
41501
US

IV. Provider business mailing address

PO BOX 3339 1330 SOUTH MAYO TRAIL, SUITE 201
PIKEVILLE KY
41502
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-0123
  • Fax: 606-433-1414
Mailing address:
  • Phone: 606-432-0123
  • Fax: 606-433-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RAKESH SACHDEVA
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 606-432-0123