Provider Demographics
NPI:1144382698
Name:AMBULATORY CARE SERVICES PLLC
Entity type:Organization
Organization Name:AMBULATORY CARE SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-668-9076
Mailing Address - Street 1:12 JACKSON HTS
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-6500
Mailing Address - Country:US
Mailing Address - Phone:606-693-0199
Mailing Address - Fax:606-666-9480
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:CAMPTON MEDICAL ARTS, SUITE I
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9750
Practice Address - Country:US
Practice Address - Phone:606-668-9076
Practice Address - Fax:606-668-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY31000961Medicaid
KY31000961Medicaid