Healthcare Provider Details

I. General information

NPI: 1831217678
Provider Name (Legal Business Name): J.C. SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N KEENELAND DR STE. 4
RICHMOND KY
40475-8597
US

IV. Provider business mailing address

425 N KEENELAND DR STE. 4
RICHMOND KY
40475-8597
US

V. Phone/Fax

Practice location:
  • Phone: 502-454-7788
  • Fax: 502-451-9291
Mailing address:
  • Phone: 502-454-7788
  • Fax: 502-451-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA130
License Number StateKY

VIII. Authorized Official

Name: JESSE CHRISTIAN
Title or Position: OWNER
Credential: KCSA
Phone: 502-454-7788