Basic Information
| Provider Information | |||||||||
| NPI: | 1801902341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST KENTUCKY SURGICAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S 8TH ST | ||||||||
| Address2: | SUITE 401E | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707532444 | ||||||||
| FaxNumber: | 2707673644 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S 8TH ST | ||||||||
| Address2: | SUITE 401E | ||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707532444 | ||||||||
| FaxNumber: | 2707673644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | DOWDY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | CRAIG | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2707532444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CB3611 | 01 | KY | MEDICARE RAILROAD | OTHER | 65933855 | 05 | KY | MEDICAID |