Provider Demographics
NPI:1962518498
Name:PADUCAH NEUROSURGICAL ASSOCIATES, PSC
Entity type:Organization
Organization Name:PADUCAH NEUROSURGICAL ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANKTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:270-443-6472
Mailing Address - Street 1:2603 KENTUCKY AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3830
Mailing Address - Country:US
Mailing Address - Phone:270-443-6472
Mailing Address - Fax:270-442-1649
Practice Address - Street 1:2603 KENTUCKY AVE STE 404
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3830
Practice Address - Country:US
Practice Address - Phone:270-443-6472
Practice Address - Fax:270-442-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65906547Medicaid
KYW93203Medicare UPIN
KY6457Medicare ID - Type Unspecified