Provider Demographics
NPI:1437271079
Name:CHARLES D. TUCKER, M.D., PSC
Entity Type:Organization
Organization Name:CHARLES D. TUCKER, M.D., PSC
Other - Org Name:MURRAY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-753-8724
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 382
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-753-8724
Mailing Address - Fax:270-767-3638
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 382
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2400
Practice Address - Country:US
Practice Address - Phone:270-753-8724
Practice Address - Fax:270-767-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64228737Medicaid
KY000000048949OtherBCBS
KY3425OtherBCBS
KY000000048949OtherBCBS
KYS21479Medicare UPIN
KY6885Medicare PIN