Healthcare Provider Details

I. General information

NPI: 1326048091
Provider Name (Legal Business Name): LOURDES AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR STE 105
PADUCAH KY
42003-7934
US

IV. Provider business mailing address

PO BOX 638982
CINCINNATI OH
45263-8982
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4125
  • Fax: 270-441-4171
Mailing address:
  • Phone: 270-441-4500
  • Fax: 270-441-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL YUNGMANN
Title or Position: PRESIDENT
Credential:
Phone: 270-444-2980