Provider Demographics
NPI:1235264565
Name:WESTERN KENTUCKY SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WESTERN KENTUCKY SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:VAN METER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-886-1274
Mailing Address - Street 1:1722 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1936
Mailing Address - Country:US
Mailing Address - Phone:270-886-1274
Mailing Address - Fax:270-886-8307
Practice Address - Street 1:1722 HIGH ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1936
Practice Address - Country:US
Practice Address - Phone:270-886-1274
Practice Address - Fax:270-886-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65946204Medicaid
KY00274Medicare PIN