Basic Information
| Provider Information | |||||||||
| NPI: | 1508805870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | K G SAHETYA PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 90039 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421029039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707968800 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 US 31W BYP | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707968800 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 04/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | SAHETYA | ||||||||
| AuthorizedOfficialFirstName: | KALIDAS | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707968800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 20980 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 000000050059 | 01 | KY | ANTHEM BC BS | OTHER | 64209802 | 05 | KY | MEDICAID |