Provider Demographics
NPI:1124304274
Name:ST. MATTHEWS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ST. MATTHEWS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:VUNETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-1794
Mailing Address - Street 1:4130 DUTCHMANS LN STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4709
Mailing Address - Country:US
Mailing Address - Phone:502-238-7293
Mailing Address - Fax:502-238-1285
Practice Address - Street 1:4130 DUTCHMANS LN STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4709
Practice Address - Country:US
Practice Address - Phone:502-238-7293
Practice Address - Fax:502-238-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical