Provider Demographics
NPI:1841570363
Name:KENTUCKY MSO LLC
Entity Type:Organization
Organization Name:KENTUCKY MSO LLC
Other - Org Name:VERSAILLES GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RAPLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:360 AMSDEN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1851
Mailing Address - Country:US
Mailing Address - Phone:859-879-2419
Mailing Address - Fax:859-873-4990
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:859-879-2419
Practice Address - Fax:859-873-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty