Provider Demographics
NPI:1972554855
Name:BARIATRIC SURGICAL ASSOCIATES,PLLC
Entity type:Organization
Organization Name:BARIATRIC SURGICAL ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIGHBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-967-5520
Mailing Address - Street 1:160 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2121
Mailing Address - Country:US
Mailing Address - Phone:859-967-5520
Mailing Address - Fax:859-967-5444
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-4960
Practice Address - Fax:859-278-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDD1130OtherRRMC GROUP
KYDD1130OtherRRMC GROUP