Organization
UNIVERSITY SURGICAL ASSOCIATES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY D. CROCKETT CEO (CEO)
(502) 583-8303
Entity
Organization
Contact information
Practice address
401 E CHESTNUT ST, SUITE 710, LOUISVILLE, KY 40202-5700
(502) 583-8303
(502) 584-0302
Mailing address
401 E CHESTNUT ST, SUITE 710, LOUISVILLE, KY 40202-5700
(502) 583-8303
(502) 584-0302
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001110A
—
IN
01
—
1051066
PASSPORT
KY
05
—
65900946
—
KY
Enumeration date
01/31/2006
Last updated
12/21/2011
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