Provider Demographics
NPI:1295854735
Name:CENTRAL KY SURGICAL ASSISTING
Entity type:Organization
Organization Name:CENTRAL KY SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:KCSA
Authorized Official - Phone:502-454-7788
Mailing Address - Street 1:795 PICNIC HILL RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7184
Mailing Address - Country:US
Mailing Address - Phone:502-454-7788
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:795 PICNIC HILL RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7184
Practice Address - Country:US
Practice Address - Phone:502-454-7788
Practice Address - Fax:502-451-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty