Active NPI
Matthew Shoulders, KCSA
- Surgical Technologist
- Frankfort, KY
National Provider Identifier
1487982294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- SA206
- Practice address
- 311 Cedar Way
Frankfort, KY 40601-9003 - Phone
- (502) 454-7766
- Fax
- (502) 454-7788
- NPI assigned
- Dec 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | SA206 | KY | Primary |
Addresses
Primary practice location
311 Cedar Way
Frankfort, KY 40601-9003
Mailing address
311 Cedar Way
Frankfort, KY 40601-9003
Phone (502) 454-7766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA206 | KY | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260144000000",
"number": "1487982294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 CEDAR WAY",
"city": "FRANKFORT",
"state": "KY",
"postal_code": "406019003",
"telephone_number": "502-454-7766",
"fax_number": "502-454-7788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 CEDAR WAY",
"city": "FRANKFORT",
"state": "KY",
"postal_code": "406019003",
"telephone_number": "502-454-7766",
"fax_number": "502-454-7788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOULDERS",
"first_name": "MATTHEW",
"credential": "KCSA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-07",
"last_updated": "2009-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "KY",
"license": "SA206",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frankfort, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.