Provider Demographics
NPI:1316155740
Name:SURE CARE SURGICAL FIRST ASSISTANCE, LLC
Entity type:Organization
Organization Name:SURE CARE SURGICAL FIRST ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:502-384-3040
Mailing Address - Street 1:9730 TIMBERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3507
Mailing Address - Country:US
Mailing Address - Phone:502-384-3040
Mailing Address - Fax:502-384-3040
Practice Address - Street 1:4119 BROWNS LN
Practice Address - Street 2:STE 2B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-454-7766
Practice Address - Fax:502-451-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY92480246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000351525OtherANTHEM