NPIMap

Organization Active NPI

Kentucky Laparoscopic & Advanced Surgical Specialists, PLLC

  • Surgery Physician
  • Prestonsburg, KY
National Provider Identifier
1194929943
Registry record updated Mar 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
02979 Issued in KY
Legal business name
KENTUCKY LAPAROSCOPIC & ADVANCED SURGICAL SPECIALISTS, PLLC
Practice address
5322 Ky Route 321
Suite 1
Prestonsburg, KY 41653-9114
Phone
(606) 886-8240
Fax
(606) 886-8243
NPI assigned
Jun 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jody Michael Johnson, D.O.
Title
Owner
Phone
(606) 886-8240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 02979 KY Primary

Addresses

Primary practice location

5322 Ky Route 321
Suite 1
Prestonsburg, KY 41653-9114

Mailing address

PO Box 1239
Prestonsburg, KY 41653-5239
Phone (606) 886-8240

National Provider Directory

National Provider Directory

Locations

5322 Ky Route 321
#1
Prestonsburg, KY 41653
Phone (606) 886-8240

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1194929943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416535239",
            "telephone_number": "606-886-8240",
            "fax_number": "606-886-8243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5322 KY ROUTE 321",
            "address_2": "SUITE 1",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416539114",
            "telephone_number": "606-886-8240",
            "fax_number": "606-886-8243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY LAPAROSCOPIC & ADVANCED SURGICAL SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JODY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-886-8240",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": "02979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.