Basic Information
Provider Information
NPI: 1871832949
EntityType: 2
ReplacementNPI:  
OrganizationName: PROFESSIONAL SURGICAL ASSISTING SERVICES
LastName:  
FirstName:  
MiddleName:  
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NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 116 BRITTANY LN
Address2:  
City: GLASGOW
State: KY
PostalCode: 421415120
CountryCode: US
TelephoneNumber: 2702029006
FaxNumber: 8004974153
Practice Location
Address1: 1301 N RACE ST
Address2:  
City: GLASGOW
State: KY
PostalCode: 421413454
CountryCode: US
TelephoneNumber: 2706514444
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/08/2013
LastUpdateDate: 02/08/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MINTON
AuthorizedOfficialFirstName: BILLY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2702029006
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: SA-C, KCSA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZS0410X0626254KYY193200000X MULTI-SPECIALTY GROUP   

No ID Information.


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