Healthcare Provider Details

I. General information

NPI: 1003369216
Provider Name (Legal Business Name): CRESTVIEW HILLS SURGERY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 THOMAS MORE PKWY UPPR LEVEL
CRESTVIEW HILLS KY
41017-3429
US

IV. Provider business mailing address

210 THOMAS MORE PKWY UPPR LEVEL
CRESTVIEW HILLS KY
41017-3429
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-4555
  • Fax: 859-331-6555
Mailing address:
  • Phone: 859-331-4555
  • Fax: 859-331-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENDALL E. HANSEN
Title or Position: OWNER
Credential:
Phone: 859-957-0700