Provider Demographics
NPI:1508174616
Name:SUSAN E NEIL MD. PSC
Entity Type:Organization
Organization Name:SUSAN E NEIL MD. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-6345
Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:STE 206
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-278-6345
Mailing Address - Fax:
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:STE 206
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-278-6345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26109261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYE46543Medicare UPIN