1144433145 NPI number — R.B. SURGICAL ASSISTANTS

Table of content: (NPI 1144433145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144433145 NPI number — R.B. SURGICAL ASSISTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R.B. SURGICAL ASSISTANTS
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:
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:
1144433145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40362-5327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-514-6675
Provider Business Mailing Address Fax Number:
859-514-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SKYVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-514-6675
Provider Business Practice Location Address Fax Number:
859-514-5962
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BODEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-747-5632

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  SA044 , 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)

  • Identifier: 000000208713 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 20751 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 49-00060 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1186178 . This is a "CHA HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7476361 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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