Provider Demographics
NPI:1447886163
Name:SURGERY CENTER OF KENTUCKY
Entity type:Organization
Organization Name:SURGERY CENTER OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATEFEH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-417-2575
Mailing Address - Street 1:9219 US HIGHWAY 42 # D174
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8857
Mailing Address - Country:US
Mailing Address - Phone:502-417-2575
Mailing Address - Fax:
Practice Address - Street 1:1003 N DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-417-2575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy