Provider Demographics
NPI:1285930461
Name:THE EYE SURGERY CENTER OF PADUCAH
Entity type:Organization
Organization Name:THE EYE SURGERY CENTER OF PADUCAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC, INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIJUANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARBRA-FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:270-442-1671
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7909
Mailing Address - Country:US
Mailing Address - Phone:270-442-1671
Mailing Address - Fax:270-442-7307
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7909
Practice Address - Country:US
Practice Address - Phone:270-442-1671
Practice Address - Fax:270-442-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300083261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical