Provider Demographics
NPI:1831217678
Name:J.C. SURGICAL ASSISTING
Entity type:Organization
Organization Name:J.C. SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:KCSA
Authorized Official - Phone:502-454-7788
Mailing Address - Street 1:425 N KEENELAND DR
Mailing Address - Street 2:STE. 4
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8597
Mailing Address - Country:US
Mailing Address - Phone:502-454-7788
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:425 N KEENELAND DR
Practice Address - Street 2:STE. 4
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8597
Practice Address - Country:US
Practice Address - Phone:502-454-7788
Practice Address - Fax:502-451-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA130246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty