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General NPI Number Information
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NPI Number | 1801979448
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Entity Type | Organization
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Legal Business Name | THE SURGICENTER
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 501 DARBY CREEK RD SUITE 57
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-263-8083
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Fax | 859-263-9160
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Provider Business Mailing Address
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Address Line | 501 DARBY CREEK RD SUITE 57
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-263-8083
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Fax | 859-263-9160
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANDRA BOUZAGLOU
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Credential | M.D.
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Telephone | 859-263-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 25984
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License Number State | KY
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