Organization
LAKE CITY SURGICAL ASSISTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY TYLER MANN CSFA KCSA (CEO)
(270) 250-1256
Entity
Organization
Contact information
Practice address
3602 WOODHAVEN DR, SOMERSET, KY 42503-9512
(270) 250-1256
Mailing address
3602 WOODHAVEN DR, SOMERSET, KY 42503-9512
(270) 250-1256
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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