Provider Demographics
NPI:1609102805
Name:CENTRAL KENTUCKY SURGERY, PSC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY SURGERY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-3576
Mailing Address - Street 1:1110 LANCASTER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8792
Mailing Address - Country:US
Mailing Address - Phone:859-623-3576
Mailing Address - Fax:859-624-9682
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 350
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:800-559-6614
Practice Address - Fax:859-624-9682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL KENTUCKY SURGERY, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-22
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65921579Medicaid
8218Medicare PIN