Provider Demographics
NPI:1942651237
Name:THIRD STREET SURGICAL CENTER
Entity Type:Organization
Organization Name:THIRD STREET SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KNETSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-238-7746
Mailing Address - Street 1:236 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1876
Mailing Address - Country:US
Mailing Address - Phone:859-238-7746
Mailing Address - Fax:859-236-0261
Practice Address - Street 1:236 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1876
Practice Address - Country:US
Practice Address - Phone:859-238-7746
Practice Address - Fax:859-236-0261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRALKENTUCKY SPINE SURGERY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty