Provider Demographics
NPI:1508879156
Name:MORNING STAR SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:MORNING STAR SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-692-0735
Mailing Address - Street 1:325 W WALNUT ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1377
Mailing Address - Country:US
Mailing Address - Phone:270-692-0735
Mailing Address - Fax:270-699-3783
Practice Address - Street 1:325 W WALNUT ST
Practice Address - Street 2:STE 300
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1377
Practice Address - Country:US
Practice Address - Phone:270-692-0735
Practice Address - Fax:270-699-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39872208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty