Healthcare Provider Details

I. General information

NPI: 1356904064
Provider Name (Legal Business Name): VANGUARD SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 TERRA CROSSING BLVD STE 375
LOUISVILLE KY
40245-5395
US

IV. Provider business mailing address

2401 TERRA CROSSING BLVD STE 375
LOUISVILLE KY
40245-5395
US

V. Phone/Fax

Practice location:
  • Phone: 502-912-8300
  • Fax:
Mailing address:
  • Phone: 502-912-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL G HUGHES JR.
Title or Position: OWNER
Credential: MD
Phone: 502-905-7413