Provider Demographics
NPI:1194904490
Name:ASHLAND PLASTIC SURGERY INC PSC
Entity type:Organization
Organization Name:ASHLAND PLASTIC SURGERY INC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:606-324-7146
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-5044
Mailing Address - Fax:606-408-5176
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-324-7146
Practice Address - Fax:606-324-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050196OtherBCBS
KY64295611Medicaid
KYCM2911OtherRR MEDICARE GROUP PIN
KYE50293Medicare UPIN