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General NPI Number Information
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NPI Number | 1508879156
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Entity Type | Organization
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Legal Business Name | MORNING STAR SURGICAL SERVICES PLLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 W WALNUT ST STE 300
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City | LEBANON
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State | KY
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Zip | 40033-1377
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Country | US
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Telephone | 270-692-0735
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Fax | 270-699-3783
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Provider Business Mailing Address
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Address Line | 325 W WALNUT ST STE 300
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City | LEBANON
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State | KY
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Zip | 40033-1377
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Country | US
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Telephone | 270-692-0735
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Fax | 270-699-3783
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Authorized Official
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Title or Position | OWNER
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Name | TODD TOM
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Credential | MD
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Telephone | 270-692-0735
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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 | 39872
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License Number State | KY
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