Healthcare Provider Details

I. General information

NPI: 1316394927
Provider Name (Legal Business Name): SURGICAL ASSISTANTS OF LOUISVILLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 RAMONA AVE
LOUISVILLE KY
40220-2440
US

IV. Provider business mailing address

3550 RAMONA AVE
LOUISVILLE KY
40220-2440
US

V. Phone/Fax

Practice location:
  • Phone: 502-819-5593
  • Fax: 502-713-7720
Mailing address:
  • Phone: 502-819-5593
  • Fax: 502-713-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number28143085A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28143085A
License Number StateIN

VIII. Authorized Official

Name: MR. SEAN F MARTINDALE
Title or Position: OWNER
Credential: APRN
Phone: 502-819-5593