Provider Demographics
NPI:1144433145
Name:R.B. SURGICAL ASSISTANTS
Entity type:Organization
Organization Name:R.B. SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:502-747-5632
Mailing Address - Street 1:PO BOX 5327
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40362-5327
Mailing Address - Country:US
Mailing Address - Phone:859-514-6675
Mailing Address - Fax:859-514-5962
Practice Address - Street 1:320 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1039
Practice Address - Country:US
Practice Address - Phone:859-514-6675
Practice Address - Fax:859-514-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA044246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000208713OtherANTHEM
KY20751OtherBLUEGRASS FAMILY HEALTH
KY49-00060OtherUNITED HEALTHCARE
KY1186178OtherCHA HEALTH
KY7476361OtherAETNA