Basic Information
| Provider Information | |||||||||
| NPI: | 1598745283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL CARE ASSOCIATES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4003 KRESGE WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028975139 | ||||||||
| FaxNumber: | 5028966218 | ||||||||
| Practice Location | |||||||||
| Address1: | 4003 KRESGE WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028975139 | ||||||||
| FaxNumber: | 5028966218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5028975139 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 2086S0129X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 300020930 | 05 | IN | MEDICAID | 7100623120 | 05 | KY | MEDICAID | 65900516 | 05 | KY | MEDICAID | 7100628950 | 05 | KY | MEDICAID |