# S DOUGLAS DEITCH MD PSC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770779084
- **Authorized official:** DR. STEPHEN DOUGLAS DEITCH MD (OWNER)
- **Authorized official phone:** (606) 325-3299

## Contact information

- **Practice address:** 2301 LEXINGTON AVE, SUITE 310, ASHLAND, KY 41101-2873
- **Practice address phone:** (606) 325-3299
- **Practice address fax:** (606) 325-1386
- **Mailing address:** 2301 LEXINGTON AVE, SUITE 310, ASHLAND, KY 41101-2873
- **Mailing address phone:** (606) 325-3299
- **Mailing address fax:** (606) 325-1386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 26535 | KY | Yes |

## Other

- **Enumeration date:** 09/20/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000049311 | BLUE CROSS | KY |
| 05 | — | 0042484000 | — | WV |
| 05 | — | 0742594 | — | OH |
| 01 | — | 1030745 | WEST VIRGINIA WORKERS COM | KY |
| 01 | — | 1389552 | UMWA | KY |
| 01 | — | 1498201 | MEDICARE ID | KY |
| 01 | — | 4347345 | AETNA | KY |
| 01 | — | 4982 | MEDICARE ID GROUP | KY |
| 05 | — | 64265358 | — | KY |