Healthcare Provider Details

I. General information

NPI: 1194904490
Provider Name (Legal Business Name): ASHLAND PLASTIC SURGERY INC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST
ASHLAND KY
41101-2880
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-7146
  • Fax: 606-324-5165
Mailing address:
  • Phone: 606-408-5044
  • Fax: 606-408-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM B ROGERS III
Title or Position: PRESIDENT
Credential: MD
Phone: 606-324-7146