Provider Demographics
NPI:1841284742
Name:KLEINERT KUTZ SURGERY CENTER, LLC
Entity type:Organization
Organization Name:KLEINERT KUTZ SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-561-4263
Mailing Address - Street 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1846
Mailing Address - Country:US
Mailing Address - Phone:502-561-4263
Mailing Address - Fax:502-561-4221
Practice Address - Street 1:3605 NORTHGATE CT
Practice Address - Street 2:STE 101
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6400
Practice Address - Country:US
Practice Address - Phone:812-944-4263
Practice Address - Fax:812-944-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN008508261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
C67930Medicare UPIN
I11393Medicare UPIN
H25257Medicare UPIN
C66369Medicare UPIN
C66463Medicare UPIN
C72393Medicare UPIN
D34192Medicare UPIN
G15959Medicare UPIN
I08512Medicare UPIN
D82706Medicare UPIN
D32297Medicare UPIN
H48985Medicare UPIN