Organization
NORTHEASTERN KENTUCKY SURGEONS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LEGENZA (BUSINESS MANAGER)
(606) 325-1151
Entity
Organization
Contact information
Practice address
617 23RD ST, SUITE 13, ASHLAND, KY 41101-2845
(606) 325-1151
(606) 324-4168
Mailing address
617 23RD ST, SUITE 13, ASHLAND, KY 41101-2845
(606) 325-1151
(606) 324-4168
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31L2
BLUE SHIELD
KY
05
—
65936429
—
KY
Enumeration date
12/14/2005
Last updated
08/22/2020
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