Provider Demographics
NPI:1396260931
Name:COLORECTAL SURGICAL & GASTROENTEROLOGY ASSOCIATES PSC
Entity type:Organization
Organization Name:COLORECTAL SURGICAL & GASTROENTEROLOGY ASSOCIATES PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:859-278-6031
Mailing Address - Street 1:2620 WILHITE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3385
Mailing Address - Country:US
Mailing Address - Phone:859-278-0185
Mailing Address - Fax:859-278-0254
Practice Address - Street 1:2620 WILHITE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3385
Practice Address - Country:US
Practice Address - Phone:859-278-0185
Practice Address - Fax:859-278-0254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORECTAL SURGICAL & GASTROENTEROLOGY ASSOCIATES PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical