Provider Demographics
NPI:1265518070
Name:BIG SANDY SURGICAL PRACTICE, PLLC
Entity type:Organization
Organization Name:BIG SANDY SURGICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARUQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-889-8895
Mailing Address - Street 1:5230 KY ROUTE 321
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9168
Mailing Address - Country:US
Mailing Address - Phone:606-889-8895
Mailing Address - Fax:606-889-8896
Practice Address - Street 1:5230 KY ROUTE 321
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9168
Practice Address - Country:US
Practice Address - Phone:606-889-8895
Practice Address - Fax:606-889-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty