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General NPI Number Information
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NPI Number | 1497970743
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY SURGICAL INSTITUTE, PSC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 1878 OLD LEBANON RD
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9663
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Country | US
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Telephone | 270-465-7505
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Fax | 270-789-3860
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Provider Business Mailing Address
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Address Line | PO BOX 1114
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42719-1114
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Country | US
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Telephone | 270-465-7505
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Fax | 270-789-3860
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID E BENTLEY
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Credential | M.D., FACS
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Telephone | 270-465-7505
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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 | 24667
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License Number State | KY
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