MEDICARE: BUFFALO TRACE EAR, NOSE & THROAT CENTER

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	34006187S	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000050862	OTHER	KY	ANTHEM ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871673046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUFFALO TRACE EAR, NOSE & THROAT CENTER

Provider Business Mailing Address
First Line	:	4980 AA HWY N
Second Line	:
City	:	FOSTER
State	:	KY
Zip	:	41043-9271
Country	:	US
Telephone Number	:	606-747-5077
Fax Number	:	606-759-5773

Provider Business Practice Location Address
First Line	:	1925 OLD MAIN ST
Second Line	:	SUITE 1
City	:	MAYSVILLE
State	:	KY
Zip	:	41056-8984
Country	:	US
Telephone Number	:	606-759-5286
Fax Number	:	606-759-5773

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALFRED M SASSLER
Credential	:	DO
Telephone Number	:	606-759-5286

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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Directions to “BUFFALO TRACE EAR, NOSE & THROAT CENTER ” Practice Location

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