Provider Demographics
NPI:1720190093
Name:BROWNSBORO PLASTIC AND HAND SURGERY, INC
Entity type:Organization
Organization Name:BROWNSBORO PLASTIC AND HAND SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:502-897-1441
Mailing Address - Street 1:6002 BROWNSBORO PARK BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1298
Mailing Address - Country:US
Mailing Address - Phone:502-897-1441
Mailing Address - Fax:502-897-3234
Practice Address - Street 1:6002 BROWNSBORO PARK BLVD STE E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1298
Practice Address - Country:US
Practice Address - Phone:502-897-1441
Practice Address - Fax:502-897-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26468208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1052955Medicaid
KYE07411Medicare UPIN
KY1052955Medicaid