Provider Demographics
NPI:1922187475
Name:CARROLLTON SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:CARROLLTON SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASTRUSERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-732-9922
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008
Mailing Address - Country:US
Mailing Address - Phone:502-732-3299
Mailing Address - Fax:502-732-8551
Practice Address - Street 1:309 ELEVENTH STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008
Practice Address - Country:US
Practice Address - Phone:502-732-3299
Practice Address - Fax:502-732-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty