Healthcare Provider Details

I. General information

NPI: 1689401465
Provider Name (Legal Business Name): PADUCAH DERMATOLOGY SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ALBEN BARKLEY DRIVE SUITE A
PADUCAH KY
42001
US

IV. Provider business mailing address

127 ALBEN BARKLEY DR STE A
PADUCAH KY
42001-4402
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-8477
  • Fax: 270-444-8479
Mailing address:
  • Phone: 270-444-8477
  • Fax: 270-444-8479

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: ERICA HOUSMAN
Title or Position: ASC ADMINISTRATOR
Credential:
Phone: 270-444-8477