Healthcare Provider Details

I. General information

NPI: 1134441819
Provider Name (Legal Business Name): RYAN SURGICAL ASSISTANCE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BLACK WATER LN
LEXINGTON KY
40511-8861
US

IV. Provider business mailing address

160 BLACK WATER LN
LEXINGTON KY
40511-8861
US

V. Phone/Fax

Practice location:
  • Phone: 859-559-2392
  • Fax: 859-971-0155
Mailing address:
  • Phone: 859-559-2392
  • Fax: 859-971-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1050326
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN R RYAN
Title or Position: PRESIDENT
Credential: RNFA
Phone: 859-559-2392