Organization
EAR, NOSE, THROAT PHYSICIANS OF EASTERN KY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SURI VANAN (MD)
(606) 432-0111
Entity
Organization
Contact information
Practice address
1330 S MAYO TRL, PIKEVILLE, KY 41501-2321
(606) 432-0111
(606) 432-4272
Mailing address
PO BOX 2140, PIKEVILLE, KY 41502-2140
(606) 432-0111
(606) 432-4272
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
34477
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000219680
ANTHEM BLUE CROSS
KY
01
—
3810002865
WV MEDICAID
WV
05
—
64344773
—
KY
Enumeration date
04/06/2006
Last updated
08/22/2020
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