Provider Demographics
NPI:1770521684
Name:SURGICAL ASSOCIATES OF LOUISVILLE, PSC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF LOUISVILLE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:VASSER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:502-895-1995
Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-895-1995
Mailing Address - Fax:502-895-6479
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-1995
Practice Address - Fax:502-895-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64297260Medicaid
KY64210628Medicaid
KY64280167Medicaid
KY64252521Medicaid
KY0225207Medicare PIN
KY0225211Medicare PIN
KYC71219Medicare UPIN
KYC66439Medicare UPIN
KY0225205Medicare PIN
KY64280167Medicaid
KY0225202Medicare PIN
KY64210628Medicaid
KY2252Medicare PIN
KYG02027Medicare UPIN
KY0225209Medicare PIN
KY0710001Medicare PIN