NPIMap

Organization Active NPI

GLK Enterprises, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Brownsville, KY
National Provider Identifier
1912912734
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
36833 Issued in KY
Legal business name
GLK ENTERPRISES, LLC
Practice address
104 Mohawk Street
Brownsville, KY 42210
Phone
(270) 597-2155
Fax
(270) 597-3811
NPI assigned
Jul 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sanjay Kaul, MDNPI 1992777866
Title
MD/President
Phone
(270) 597-2155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 36833 KY Primary

Addresses

Primary practice location

104 Mohawk Street
Brownsville, KY 42210

Mailing address

104 Mohawk Street
Brownsville, KY 42210
Phone (270) 597-2155

Other identifiers 1

IdentifierTypeStateIssuer
64030224MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061005000083 KY Part B Supplier - Clinic/Group Practice 5092711655 Receives reassigned benefits from 6 practitioners
Practice locations: Brownsville, KY

National Provider Directory

National Provider Directory
Tax ID family
GLK Enterprises2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912912734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MOHAWK STREET",
            "city": "BROWNSVILLE",
            "state": "KY",
            "postal_code": "42210",
            "telephone_number": "270-597-2155",
            "fax_number": "270-597-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MOHAWK STREET",
            "city": "BROWNSVILLE",
            "state": "KY",
            "postal_code": "42210",
            "telephone_number": "270-597-2155",
            "fax_number": "270-597-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLK ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAUL",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "270-597-2155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "KY",
            "license": "36833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64030224",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brownsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.