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General NPI Number Information
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NPI Number | 1720176522
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Entity Type | Organization
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Legal Business Name | HEMATOLOGY ONCOLOGY PHYSICIANS EAST KENTUCKY PSC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 2737 NORTH LAUREL ROAD
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City | LONDON
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State | KY
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Zip | 40741
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Country | US
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Telephone | 606-843-2783
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Fax | 606-862-4899
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Provider Business Mailing Address
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Address Line | 73 THOMPSON POYNTER ROAD SUITE B
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City | LONDON
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State | KY
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Zip | 40741
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Country | US
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Telephone | 606-344-2444
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Fax | 606-862-4899
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Authorized Official
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Title or Position | OWNER
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Name | DR. VISAHARAN SIVASUBRAMANIAM
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Credential | M.D.
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Telephone | 606-344-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 38197
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 40196
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 40196
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 38197
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License Number State | KY
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