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General NPI Number Information
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NPI Number | 1043361645
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALTIES, PSC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 250 BURKESVILLE RD
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City | ALBANY
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State | KY
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Zip | 42602-1604
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Country | US
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Telephone | 606-387-3000
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Fax | 606-387-3307
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Provider Business Mailing Address
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Address Line | 250 BURKESVILLE RD
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City | ALBANY
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State | KY
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Zip | 42602-1604
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Country | US
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Telephone | 606-387-3000
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Fax | 606-387-3307
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACY GLENN CROSS
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Credential | M.D.
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Telephone | 606-387-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 33185
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License Number State | KY
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