Provider Demographics
NPI:1972651263
Name:SANTOS MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:SANTOS MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:MAGARRO
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-668-9540
Mailing Address - Street 1:325 CAMPBELL HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0157
Mailing Address - Country:US
Mailing Address - Phone:606-668-9540
Mailing Address - Fax:
Practice Address - Street 1:325 CAMPBELL HILL ROAD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-0157
Practice Address - Country:US
Practice Address - Phone:606-668-9540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6432898200Medicaid
KY7592Medicare ID - Type Unspecified