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General NPI Number Information
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NPI Number | 1316254261
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Entity Type | Organization
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Legal Business Name | AMERICAN SURGICAL SPECIALISTS, PLLC
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 400 UNIVERSITY DR SUITE 105
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1080
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Country | US
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Telephone | 606-886-1077
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Fax | 606-886-1170
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Provider Business Mailing Address
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Address Line | 400 UNIVERSITY DR SUITE 105
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City | PRESTONSBURG
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State | KY
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Zip | 41653-1080
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Country | US
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Telephone | 606-886-1077
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Fax | 606-886-1170
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP PARKER CRACE
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Credential | MD
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Telephone | 606-886-1077
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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 | 41691
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License Number State | KY
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