Healthcare Provider Details

I. General information

NPI: 1841811866
Provider Name (Legal Business Name): WAYNE COUNTY SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CREEK DR STE 112
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

166 HOSPITAL ST
MONTICELLO KY
42633-2430
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-3341
  • Fax: 606-348-0005
Mailing address:
  • Phone: 606-340-3222
  • Fax: 606-340-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA ANN BRANSCUM
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 606-340-3222