Healthcare Provider Details

I. General information

NPI: 1750582607
Provider Name (Legal Business Name): SURGICAL ASSISTANTS OF LEXINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

PO BOX 4126
LEXINGTON KY
40544-4126
US

V. Phone/Fax

Practice location:
  • Phone: 859-502-1208
  • Fax:
Mailing address:
  • Phone: 859-502-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVEN STANLEY
Title or Position: OWNER
Credential: RNFA
Phone: 859-509-1208