Provider Demographics
NPI:1598878035
Name:NORTHERN KENTUCKY GENERAL & VASCULAR SURGEONS
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY GENERAL & VASCULAR SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-3818
Mailing Address - Street 1:3700 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1792
Mailing Address - Country:US
Mailing Address - Phone:859-441-3818
Mailing Address - Fax:859-441-1758
Practice Address - Street 1:3700 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1792
Practice Address - Country:US
Practice Address - Phone:859-441-3818
Practice Address - Fax:859-441-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926008Medicaid
KY7304Medicare PIN
KY3152Medicare ID - Type UnspecifiedMEDICARE # FOR GROUP
KY4099Medicare ID - Type UnspecifiedMEDICARE GROUP #