Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 03155 | KY |
NPI | 1154389187 |
---|---|
Provider Name | Dr. Rick Anthony Pellant |
First Address | Louisville, KY 40207-4202 |
Second Address | London, KY 40741-6668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001313601 | ANTHEM PROVIDER ID (01) | |
00825001 | MEDICARE (01) | KY |
133941KYIP | AETNA BETTER HEALTH OF KY PROVIDER ID (01) | KY |
2064077 | WELLCARE OF KY PROVIDER ID (01) | KY |
2970041 | UNITED HEALTHCARE PROVIDER ID NUMBER (01) | |
300031398 | (05) | IN |
7100062440 | (05) | KY |
CS2005900276 | CARESOURCE PROVIDER ID (01) |