Provider Demographics
NPI:1770066292
Name:MOLLY ROBERSON COMPREHENSIVE SURGICAL ASSISTANCE PLLC
Entity type:Organization
Organization Name:MOLLY ROBERSON COMPREHENSIVE SURGICAL ASSISTANCE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:502-489-4325
Mailing Address - Street 1:1064 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1532
Mailing Address - Country:US
Mailing Address - Phone:502-489-4325
Mailing Address - Fax:
Practice Address - Street 1:1064 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1532
Practice Address - Country:US
Practice Address - Phone:502-489-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty