Organization
THE SURGICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA BOUZAGLOU M.D. (PRESIDENT)
(859) 263-8083
Entity
Organization
Contact information
Practice address
501 DARBY CREEK RD, SUITE 57, LEXINGTON, KY 40509-1604
(859) 263-8083
(859) 263-9160
Mailing address
501 DARBY CREEK RD, SUITE 57, LEXINGTON, KY 40509-1604
(859) 263-8083
(859) 263-9160
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
25984
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000287196
ANTHEM PROVIDER NUMBER
KY
01
—
18D0979876
CLIA
KY
Enumeration date
10/24/2006
Last updated
10/15/2008
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