Provider Demographics
NPI:1801979448
Name:THE SURGICENTER
Entity type:Organization
Organization Name:THE SURGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZAGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-263-8083
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 57
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-263-8083
Mailing Address - Fax:859-263-9160
Practice Address - Street 1:501 DARBY CREEK RD
Practice Address - Street 2:SUITE 57
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1604
Practice Address - Country:US
Practice Address - Phone:859-263-8083
Practice Address - Fax:859-263-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25984261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000287196OtherANTHEM PROVIDER NUMBER
KY18D0979876OtherCLIA