Provider Demographics
NPI:1831149608
Name:WESTERN KENTUCKY AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:WESTERN KENTUCKY AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-887-0224
Mailing Address - Street 1:8250 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241
Mailing Address - Country:US
Mailing Address - Phone:302-542-2770
Mailing Address - Fax:302-261-0209
Practice Address - Street 1:210 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-9545
Practice Address - Country:US
Practice Address - Phone:302-542-2770
Practice Address - Fax:302-261-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical