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General NPI Number Information
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NPI Number | 1902956949
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Entity Type | Organization
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Legal Business Name | GLASGOW SURGICAL ASSOCIATES PSC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 1216 B NORTH RACE STREET
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City | GLASGOW
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State | KY
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Zip | 42141
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Country | US
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Telephone | 270-651-9408
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Fax | 270-651-6023
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Provider Business Mailing Address
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Address Line | PO BOX 818
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City | GLASGOW
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State | KY
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Zip | 42142-0818
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Country | US
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Telephone | 270-651-9408
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Fax | 270-651-6023
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL TODD MARION
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Credential | MD
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Telephone | 270-651-9408
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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 | 27369
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License Number State | KY
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