Provider Demographics
NPI:1255417887
Name:LEBANON SURGICAL ASSOCIATES, P.S.C.
Entity type:Organization
Organization Name:LEBANON SURGICAL ASSOCIATES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORROH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-692-2222
Mailing Address - Street 1:496 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1362
Mailing Address - Country:US
Mailing Address - Phone:270-692-2222
Mailing Address - Fax:270-692-1041
Practice Address - Street 1:496 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1362
Practice Address - Country:US
Practice Address - Phone:270-692-2222
Practice Address - Fax:270-692-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYE83754Medicare UPIN