Provider Demographics
NPI:1639369176
Name:GUARDIAN CARE SURGICAL PSC
Entity Type:Organization
Organization Name:GUARDIAN CARE SURGICAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-638-4822
Mailing Address - Street 1:20 MEDICAL HTS
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9603
Mailing Address - Country:US
Mailing Address - Phone:606-638-4822
Mailing Address - Fax:606-638-4820
Practice Address - Street 1:20 MEDICAL HTS
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9603
Practice Address - Country:US
Practice Address - Phone:606-638-4822
Practice Address - Fax:606-638-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27564261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64275647Medicaid
KY64275647Medicaid