Basic Information
| Provider Information | |||||||||
| NPI: | 1326048091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOURDES AMBULATORY SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8329 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420028329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704414125 | ||||||||
| FaxNumber: | 2704414171 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420037914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704414125 | ||||||||
| FaxNumber: | 2704414171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 03/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | YUNGMANN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2704442980 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.