Provider Demographics
NPI:1841236809
Name:SURGICAL GROUP OF PADUCAH P.S.C.
Entity Type:Organization
Organization Name:SURGICAL GROUP OF PADUCAH P.S.C.
Other - Org Name:SURGICAL GROUP P.S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-538-9555
Mailing Address - Street 1:PO BOX 8468
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8468
Mailing Address - Country:US
Mailing Address - Phone:270-538-9555
Mailing Address - Fax:270-538-9554
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:DOCTOR BLDG. 1 SUITE 201
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8468
Practice Address - Country:US
Practice Address - Phone:270-538-9555
Practice Address - Fax:270-538-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00072Medicare PIN