MEDICARE: PRESCOTT PLASTIC SURGERY & MED SPA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD3586	OTHER	KY	RR MCR

General Provider Information

NPI Number	:	1124125497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT PLASTIC SURGERY & MED SPA PLLC

Provider Business Mailing Address
First Line	:	2507 BUSH RIDGE DR STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-589-8000
Fax Number	:	502-589-8001

Provider Business Practice Location Address
First Line	:	2507 BUSH RIDGE DR STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-5885
Country	:	US
Telephone Number	:	502-589-8000
Fax Number	:	502-589-8001

Authorized Official
Title or Position	:	OWNER/ PROVIDER
Name	:	ANGELA PRESCOTT
Credential	:	MD
Telephone Number	:	502-589-8000

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/19/2025

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