Organization
PADUCAH SURGICAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUE ELLEN PETTY M.D. (CEO)
(270) 441-7777
Entity
Organization
Contact information
Practice address
2603 KENTUCKY AVE STE 304, PADUCAH, KY 42003-3829
(270) 441-7777
(270) 441-7764
Mailing address
2603 KENTUCKY AVE STE 304, PADUCAH, KY 42003-3829
(270) 441-7777
(270) 441-7764
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34383
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34383
STATE LICENSE
KY
05
—
64343833
—
KY
Enumeration date
02/13/2007
Last updated
07/01/2010
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