Provider Demographics
NPI:1912148875
Name:CENTRAL KENTUCKY ADVANCED SURGERY &
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY ADVANCED SURGERY &
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:SONNANSTINE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:502-867-3303
Mailing Address - Street 1:1138 LEXINGTON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9672
Mailing Address - Country:US
Mailing Address - Phone:502-867-3303
Mailing Address - Fax:502-867-3304
Practice Address - Street 1:1138 LEXINGTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9672
Practice Address - Country:US
Practice Address - Phone:502-867-3303
Practice Address - Fax:502-867-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38960208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00956Medicare PIN