Provider Demographics
NPI:1386826261
Name:LOURDES MEDICAL PAVILION
Entity Type:Organization
Organization Name:LOURDES MEDICAL PAVILION
Other - Org Name:SURGICARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-441-4181
Mailing Address - Street 1:PO BOX 8329
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8329
Mailing Address - Country:US
Mailing Address - Phone:270-441-4125
Mailing Address - Fax:270-441-4171
Practice Address - Street 1:225 MEDICAL CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4500
Practice Address - Fax:270-441-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300114261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYASC1027Medicare PIN