| Oral Surgery Group Of Middletown, Pllc | |
|
134 Evergreen Rd Middletown KY 40243-1487 | |
| (502) 410-1702 | |
| Not Available |
| Full Name | Oral Surgery Group Of Middletown, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 134 Evergreen Rd, Middletown, Kentucky |
| Authorized Official Name and Position | Kathie Armstrong (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 5028548501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral Surgery Group Of Middletown, Pllc Po Box 437169 Louisville KY 40253-7169 Ph: () - | Oral Surgery Group Of Middletown, Pllc 134 Evergreen Rd Middletown KY 40243-1487 Ph: (502) 410-1702 |
| NPI Number | 1497070148 |
|---|---|
| Provider Enumeration Date | 04/06/2010 |
| Last Update Date | 07/01/2013 |
| Medicare PECOS PAC ID | 8022280957 |
|---|---|
| Medicare Enrollment ID | O20111018000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497070148 | NPI | - | NPPES |
| Provider Name | Brent W Mortenson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1356369169 PECOS PAC ID: 7315954187 Enrollment ID: I20060320000475 |
| Provider Name | Maneesh Mohan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1154310985 PECOS PAC ID: 9032354741 Enrollment ID: I20130401000160 |
| Provider Name | David A Naselsker |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790944106 PECOS PAC ID: 1557582202 Enrollment ID: I20180911001606 |
| Provider Name | Alexander B Musser |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053756502 PECOS PAC ID: 1052553708 Enrollment ID: I20180918000810 |
| Provider Name | Stephen H Sutley |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124030085 PECOS PAC ID: 5092815944 Enrollment ID: I20190312001836 |
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