Healthcare Provider Details

I. General information

NPI: 1881684538
Provider Name (Legal Business Name): MCPEAK SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BRAVO BLVD
GLASGOW KY
42141-3478
US

IV. Provider business mailing address

108 BRAVO BLVD
GLASGOW KY
42141-3478
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-2181
  • Fax: 270-651-2183
Mailing address:
  • Phone: 270-651-2181
  • Fax: 270-651-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number300060
License Number StateKY

VIII. Authorized Official

Name: DR. SPENCER WITCHER
Title or Position: OWNER
Credential: MD
Phone: 270-651-2181