1114216777 NPI number — AMERICAN SURGICAL SPECIALISTS, PLLC

Table of content: KEVIN ROY SWAN M.D. (NPI 1215112578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114216777 NPI number — AMERICAN SURGICAL SPECIALISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN SURGICAL SPECIALISTS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114216777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTONSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41653-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-886-1077
Provider Business Mailing Address Fax Number:
606-886-1170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PRESTONSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41653-1080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-886-1077
Provider Business Practice Location Address Fax Number:
606-886-1170
Provider Enumeration Date:
04/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRACE
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
PARKER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-886-1077

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  41691 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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