Healthcare Provider Details

I. General information

NPI: 1932228137
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF CENTRAL KY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date: 12/03/2007
Reactivation Date: 01/22/2008

III. Provider practice location address

212 S 2ND ST
DANVILLE KY
40422-1804
US

IV. Provider business mailing address

212 S 2ND ST
DANVILLE KY
40422-1804
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-5302
  • Fax: 859-236-5025
Mailing address:
  • Phone: 859-236-5302
  • Fax: 859-236-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A SPURLIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 859-236-5302