Kentuckiana Colon and Rectal Surgery, PLLC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

30849 Issued in KY

Legal business name

KENTUCKIANA COLON AND RECTAL SURGERY, PLLC

Practice address

4121 Dutchmans LN
Suite 515
Louisville, KY 40207-4737

Phone

(502) 583-8005

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Wayne Tuckson, MDNPI 1922039023

Title

Owner/Physician

Phone

(502) 583-8005

Specialties & licenses 2

Addresses

Other identifiers 4

Practitioners 3

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

• Wayne Tuckson, MD

  • Colon & Rectal Surgery Physician
  • Louisville, KY
  • NPI 1922039023
  NPD (past) Authorized official
• Kimberly Mosley, APRN

  • Nurse Practitioner
  • Louisville, KY
  • NPI 1083649495
  NPD (past)
• Tom Garofalo, M.D.

  • Colon & Rectal Surgery Physician
  • Cleveland, OH
  • NPI 1790742013
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1619908613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 DUTCHMANS LN",
            "address_2": "SUITE 515",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074737",
            "telephone_number": "502-583-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 DUTCHMANS LN",
            "address_2": "SUITE 515",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074737",
            "telephone_number": "502-583-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKIANA COLON AND RECTAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "TUCKSON",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "502-583-8005",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "KY",
            "license": "30849",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65934739",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100015770",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200323220A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK6017",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Colon & Rectal Surgery Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Colon & Rectal Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.