Provider Demographics
NPI:1720713506
Name:SOUTHERN KENTUCKY VASCULAR PROCEDURE CENTER, PLLC
Entity Type:Organization
Organization Name:SOUTHERN KENTUCKY VASCULAR PROCEDURE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-531-4100
Mailing Address - Street 1:25 MEDPARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-531-4100
Mailing Address - Fax:606-220-2116
Practice Address - Street 1:25 MEDPARK DR STE 3
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-531-4100
Practice Address - Fax:606-220-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty