MEDICARE: WESTERN KENTUCKY AMBULATORY SURGERY CENTER LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	PENDING	KY

General Provider Information

NPI Number	:	1831149608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN KENTUCKY AMBULATORY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	8250 EAGLE WAY
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241
Country	:	US
Telephone Number	:	302-542-2770
Fax Number	:	302-261-0209

Provider Business Practice Location Address
First Line	:	210 TANGLEWOOD DR
Second Line	:
City	:	LEWES
State	:	DE
Zip	:	19958-9545
Country	:	US
Telephone Number	:	302-542-2770
Fax Number	:	302-261-0209

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	ERIC LEE
Credential	:
Telephone Number	:	270-887-0224

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	08/22/2020

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