Provider Demographics
NPI:1144639626
Name:JEWELL SURGICAL ASSISTING LLC
Entity type:Organization
Organization Name:JEWELL SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:502-292-7676
Mailing Address - Street 1:3024 LEMAN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2524
Mailing Address - Country:US
Mailing Address - Phone:502-292-7676
Mailing Address - Fax:
Practice Address - Street 1:3024 LEMAN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2524
Practice Address - Country:US
Practice Address - Phone:502-292-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA269282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital