Provider Demographics
NPI:1679619811
Name:PHYSICIAN MANAGEMENT SERVICES PSC
Entity type:Organization
Organization Name:PHYSICIAN MANAGEMENT SERVICES PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KALIDAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAHETYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-796-8800
Mailing Address - Street 1:PO BOX 90039
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-9039
Mailing Address - Country:US
Mailing Address - Phone:270-796-8800
Mailing Address - Fax:270-796-9328
Practice Address - Street 1:1573 HWY 259N
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210
Practice Address - Country:US
Practice Address - Phone:270-597-2168
Practice Address - Fax:270-597-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900024261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001171Medicaid
KY0670601Medicare ID - Type Unspecified
KY183877Medicare Oscar/Certification