Provider Demographics
NPI:1366541971
Name:SURGICAL ASSOCIATES PSC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-633-6062
Mailing Address - Street 1:30 STONECREST CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8128
Mailing Address - Country:US
Mailing Address - Phone:502-633-6062
Mailing Address - Fax:502-633-6810
Practice Address - Street 1:30 STONECREST CT
Practice Address - Street 2:SUITE 104
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8128
Practice Address - Country:US
Practice Address - Phone:502-633-6062
Practice Address - Fax:502-633-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center