Provider Demographics
NPI:1548311806
Name:CENTRAL KENTUCKY HEAD & NECK SURGICAL ASSOCIATES, PSC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY HEAD & NECK SURGICAL ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-987-0400
Mailing Address - Street 1:24 CLINIC DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2166
Mailing Address - Country:US
Mailing Address - Phone:859-987-0400
Mailing Address - Fax:859-987-0409
Practice Address - Street 1:24 CLINIC DR
Practice Address - Street 2:SUITE B
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2166
Practice Address - Country:US
Practice Address - Phone:859-987-0400
Practice Address - Fax:859-987-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29133207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64291339Medicaid
KYG52113Medicare UPIN
1645001Medicare PIN