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General NPI Number Information
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NPI Number | 1982700027
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Entity Type | Organization
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Legal Business Name | KENTUCKY SURGICAL ASSISTANT SERVICES
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 399 MARSEE TRL
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City | CORBIN
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State | KY
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Zip | 40701-8895
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Country | US
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Telephone | 606-526-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 399 MARSEE TRL
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City | CORBIN
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State | KY
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Zip | 40701-8895
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Country | US
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Telephone | 606-526-8700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRY LEE SMITH
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Credential | CSA, KCSA
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Telephone | 606-526-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA-111
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License Number State | KY
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