Organization
KENTUCKY MSO LLC
Active
Other names
Georgetown Bariatrics & Advanced Surgical Services
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D VAUGHN (VICE PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1138 LEXINGTON RD, SUITE 230, GEORGETOWN, KY 40324-9672
(502) 570-3727
(502) 570-3753
Mailing address
1138 LEXINGTON RD, SUITE 230, GEORGETOWN, KY 40324-9672
(502) 570-3727
(502) 570-3753
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
12/04/2012
Last updated
09/22/2016
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