Healthcare Provider Details

I. General information

NPI: 1871673046
Provider Name (Legal Business Name): BUFFALO TRACE EAR, NOSE & THROAT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 OLD MAIN ST SUITE 1
MAYSVILLE KY
41056-8984
US

IV. Provider business mailing address

4980 AA HWY N
FOSTER KY
41043-9271
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5286
  • Fax: 606-759-5773
Mailing address:
  • Phone: 606-747-5077
  • Fax: 606-759-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number34006187S
License Number StateKY

VIII. Authorized Official

Name: DR. ALFRED M SASSLER
Title or Position: PRESIDENT
Credential: DO
Phone: 606-759-5286