Organization
BLUEGRASS SURGICAL ASSOCIATION, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN L KORBA MD (PRESIDENT)
(270) 782-5219
Entity
Organization
Contact information
Practice address
996 WILKINSON TRCE, SUITE A5, BOWLING GREEN, KY 42103-3407
(270) 782-5219
(270) 793-9385
Mailing address
996 WILKINSON TRCE, SUITE A5, BOWLING GREEN, KY 42103-3407
(270) 782-5219
(270) 793-9385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25747
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65924375
—
KY
Enumeration date
12/06/2006
Last updated
12/14/2010
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