Basic Information
| Provider Information | |||||||||
| NPI: | 1225200462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIANEKHAMMY | ||||||||
| FirstName: | PHONESAVANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029696552 | ||||||||
| FaxNumber: | 5029693799 | ||||||||
| Practice Location | |||||||||
| Address1: | 3118 EAST 10TH STREET | ||||||||
| Address2: | NORTON COMMUNITY MEDICAL ASSOCIATES | ||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826979 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TP138 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 99033592A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | BU6476407R519 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD0000043766 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00533076 | 01 | IN | MEDICARE IN- CMA | OTHER | 200918490 | 01 | KY | CARE SELECT- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 3525703 | 01 | KY | CIGNA- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | P00783046 | 01 | IN | RAILROAD MEDICARE- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 000023034H | 01 | KY | HUMANA- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 098947 | 01 | KY | SIHO- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 200918490 | 01 | KY | HEALTHY INDIANA PLAN- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 000000586612 | 01 | KY | ANTHEM- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 000000586939 | 01 | KY | ANTHEM INDIANA MEDICAID- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 200918490 | 01 | IN | MEDICAID- NORTON CMA | OTHER | 7100070980 | 01 | KY | MEDICAID KY- NORTON COMMUNITY MEDICAL ASSOCIATES | OTHER | 196290BBBB | 01 | IN | MEDICARE- NORTON ICC & CMA | OTHER |