Provider Demographics
NPI:1780659946
Name:SURGICAL GROUP PSC
Entity type:Organization
Organization Name:SURGICAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUDELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAZINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-441-4300
Mailing Address - Street 1:225 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7914
Mailing Address - Country:US
Mailing Address - Phone:270-441-4300
Mailing Address - Fax:270-441-4329
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4300
Practice Address - Fax:270-441-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty