Provider Demographics
NPI:1902956949
Name:GLASGOW SURGICAL ASSOCIATES PSC
Entity Type:Organization
Organization Name:GLASGOW SURGICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-651-9408
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0818
Mailing Address - Country:US
Mailing Address - Phone:270-651-9408
Mailing Address - Fax:270-651-6023
Practice Address - Street 1:1216 B NORTH RACE STREET
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-9408
Practice Address - Fax:270-651-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000046145OtherKENTUCKY ACCESS
KY000000046145OtherBLUE CROSS & BLUE SHIELD
KY64273691Medicaid
KY8439Medicare PIN
KY64273691Medicaid