Healthcare Provider Details

I. General information

NPI: 1528260734
Provider Name (Legal Business Name): KENTUCKY SURGICAL ARTS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 KY ROUTE 321 KENTUCKY SURGICAL ARTS PSC
PRESTONSBURG KY
41653-9114
US

IV. Provider business mailing address

5251 KY ROUTE 321 KENTUCKY SURGICAL ARTS PSC
PRESTONSBURG KY
41653-9114
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-0682
  • Fax: 606-886-0682
Mailing address:
  • Phone: 606-886-0682
  • Fax: 606-886-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number19463
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19259
License Number StateKY

VIII. Authorized Official

Name: MRS. KAMAR J IKRAMUDDIN
Title or Position: M.D
Credential: MD
Phone: 606-886-0682