Provider Demographics
NPI:1134441819
Name:RYAN SURGICAL ASSISTANCE, PSC
Entity type:Organization
Organization Name:RYAN SURGICAL ASSISTANCE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:859-559-2392
Mailing Address - Street 1:160 BLACK WATER LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8861
Mailing Address - Country:US
Mailing Address - Phone:859-559-2392
Mailing Address - Fax:859-971-0155
Practice Address - Street 1:160 BLACK WATER LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8861
Practice Address - Country:US
Practice Address - Phone:859-559-2392
Practice Address - Fax:859-971-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1050326163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty