Provider Demographics
NPI:1992982888
Name:KENTUCKY AESTHETIC & PLASTIC SURGERY INSTITUTE, PLLC
Entity type:Organization
Organization Name:KENTUCKY AESTHETIC & PLASTIC SURGERY INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIGENIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:502-589-5544
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-1027
Mailing Address - Country:US
Mailing Address - Phone:502-589-5544
Mailing Address - Fax:502-561-0040
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:NORTON HEALTHCARE PAVILION
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-589-5544
Practice Address - Fax:502-561-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2086S0122X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0977202Medicare PIN
KY0977201Medicare PIN