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General NPI Number Information
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NPI Number | 1871673046
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Entity Type | Organization
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Legal Business Name | BUFFALO TRACE EAR, NOSE & THROAT CENTER
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1925 OLD MAIN ST SUITE 1
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City | MAYSVILLE
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State | KY
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Zip | 41056-8984
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Country | US
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Telephone | 606-759-5286
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Fax | 606-759-5773
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Provider Business Mailing Address
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Address Line | 4980 AA HWY N
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City | FOSTER
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State | KY
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Zip | 41043-9271
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Country | US
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Telephone | 606-747-5077
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Fax | 606-759-5773
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALFRED M SASSLER
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Credential | DO
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Telephone | 606-759-5286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34006187S
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License Number State | KY
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