Provider Demographics
NPI:1639350267
Name:UNIVERSITY SURGICAL ASSOCIATES, PSC
Entity Type:Organization
Organization Name:UNIVERSITY SURGICAL ASSOCIATES, PSC
Other - Org Name:HEARCARE ASSOCIATES-HEARING AID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-583-8303
Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-583-8303
Mailing Address - Fax:502-584-0302
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 710
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-583-8303
Practice Address - Fax:502-584-0302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY SURGICAL ASSOCIATES, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-26
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50900125Medicaid
KY50900125Medicaid