Healthcare Provider Details

I. General information

NPI: 1144639626
Provider Name (Legal Business Name): JEWELL SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 LEMAN DR
LOUISVILLE KY
40220-2524
US

IV. Provider business mailing address

3024 LEMAN DR
LOUISVILLE KY
40220-2524
US

V. Phone/Fax

Practice location:
  • Phone: 502-292-7676
  • Fax:
Mailing address:
  • Phone: 502-292-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberSA269
License Number StateKY

VIII. Authorized Official

Name: MRS. ELIZABETH ANN JEWELL
Title or Position: CSA
Credential: CSA
Phone: 502-292-7676