Kentuckiana Pain Specialist Ambulatory Surgery Center
Clinic/Center, Ambulatory Surgical in Louisville, KY. Organization (NPI-2).
NPI number1083124366
StatusActive
Last updated in NPPESOct 21, 2021
Details
- NPI
- 1083124366
- Entity type
- Organization (NPI-2)
- Legal business name
- Kentuckiana Pain Specialist Ambulatory Surgery Center
- Organization subpart
- No
- Enumeration date
- Oct 2, 2017
- Certification date
- Oct 21, 2021
- Last updated
- Oct 21, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA1903X | Clinic/Center, Ambulatory Surgical | – | – | Yes |
| 174400000X | Specialist | KY36217 | KY | |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Other names
- Kps Ambulatory Surgery Center (Doing Business As)
Practice location
3710 Chamberlain Ln Ste BLouisville, KY 40241-2002
Phone 502-995-4004 · Fax 502-933-5559
Mailing address
Po Box 24321Louisville, KY 40224-0321
Phone 502-995-4004 · Fax 502-933-5559
Authorized official
Ajith Nair
Medical Director
5029954004
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