Organization
KENTUCKY LAPAROSCOPIC & ADVANCED SURGICAL SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY MICHAEL JOHNSON D.O. (OWNER)
(606) 886-8240
Entity
Organization
Contact information
Practice address
5322 KY ROUTE 321, SUITE 1, PRESTONSBURG, KY 41653-9114
(606) 886-8240
(606) 886-8243
Mailing address
PO BOX 1239, PRESTONSBURG, KY 41653-5239
(606) 886-8240
(606) 886-8243
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02979
KY
Other
Enumeration date
06/14/2007
Last updated
03/12/2009
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