MEDICARE: LEBANON SURGICAL ASSOCIATES, P.S.C.

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	174400000X	Specialist	27388	KY

General Provider Information

NPI Number	:	1255417887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEBANON SURGICAL ASSOCIATES, P.S.C.

Provider Business Mailing Address
First Line	:	496 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-2222
Fax Number	:	270-692-1041

Provider Business Practice Location Address
First Line	:	496 W MAIN ST
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-2222
Fax Number	:	270-692-1041

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDERICK A DORROH
Credential	:	M.D.
Telephone Number	:	270-692-2222

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/22/2020

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