| Thomas Lutfallah Khoury, MD | |
|
1711 27th St, Braunlin Bldg, Suite 306, Portsmouth, OH 45662-2638 | |
| (740) 353-8661 | |
| (740) 354-3254 |
| Full Name | Thomas Lutfallah Khoury |
|---|---|
| Gender | Male |
| Speciality | Surgery |
| Location | 1711 27th St, Portsmouth, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306838719 | NPI | - | NPPES |
| 64938434 | Medicaid | KY | |
| 0968690 | Medicaid | OH | |
| 6493843400 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 35.065158 (Ohio) | Primary |
| 208600000X | Surgery | 2025-01256 (North Carolina) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | 35.065158 (Ohio) | Secondary |
| Entity Name | Southern Ohio Surgical Associates, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1528050945 PECOS PAC ID: 4688569676 Enrollment ID: O20040218000763 |
| Mailing Address | Practice Location Address |
|---|---|
| Thomas Lutfallah Khoury, MD 1711 27th St, Braunlin Bldg, Suite 306, Portsmouth, OH 45662-2638 Ph: (740) 353-8661 | Thomas Lutfallah Khoury, MD 1711 27th St, Braunlin Bldg, Suite 306, Portsmouth, OH 45662-2638 Ph: (740) 353-8661 |
Dr. Joseph J Lach, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1711 27th Street, Braunlin Bldg, Suite 306, Portsmouth, OH 45662 Phone: 740-353-8661 Fax: 740-354-3254 | |
Dr. Andrew James Dittenhofer, D.O Surgery Medicare: Accepting Medicare Assignments Practice Location: 1711 27th St Ste 402, Portsmouth, OH 45662 Phone: 740-356-3562 Fax: 740-355-6938 | |
Dr. James R Pacholka, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 1711 27th St Ste 402, Portsmouth, OH 45662 Phone: 740-356-3562 Fax: 740-355-6938 | |
Mrs. Jennifer Lynn Thayer, FNP-BC Surgery Medicare: Not Enrolled in Medicare Practice Location: 1711 27th St Braunlin Bldg, Suite 306, Portsmouth, OH 45662 Phone: 740-353-8661 | |
Kent M Grosh, MD Surgery Medicare: Medicare Enrolled Practice Location: 1711 27th St Ste 402, Portsmouth, OH 45662 Phone: 740-356-3562 Fax: 740-356-1279 | |
Dr. Vincent Michael Scarpinato, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 1711 27th St Ste 402, Portsmouth, OH 45662 Phone: 740-356-3562 Fax: 740-355-6938 |