NPIMap

Organization Active NPI

Kings Daughters Medical Specialties Inc

Doing business as Kings Daughters Medical Specialties - Plastic & Reconstructive Surgeon

  • Plastic Surgery Physician
  • Ashland, KY
National Provider Identifier
1720397409
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
KINGS DAUGHTERS MEDICAL SPECIALTIES INC
Doing business as
Kings Daughters Medical Specialties - Plastic & Reconstructive Surgeon
Practice address
617 23Rd St Ste 105
Ashland, KY 41101-2890
Phone
(606) 408-7500
Fax
(606) 408-6600
NPI assigned
Sep 29, 2010
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Authorized official

Name
Sara Marks
Title
Ceo/President
Phone
(606) 408-4401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X KY Primary

Addresses

Primary practice location

617 23Rd St Ste 105
Ashland, KY 41101-2890

Mailing address

PO Box 2379
Ashland, KY 41105-2379
Phone (606) 408-2600

Other practice location 1

2001 Scioto Trl Ste 200
Portsmouth, OH 45662-2845
Phone (740) 353-8100

Other identifiers 1

IdentifierTypeStateIssuer
7100140330MedicaidKY

Other names 1

  • Kings Daughters Medical Specialties - Plastic & Reconstructive Surgeon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100114000813 OH Part B Supplier - Clinic/Group Practice 6103968029 Receives reassigned benefits from 181 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheelersburg, OH; Waverly, OH; South Point, OH; Portsmouth, OH; Lucasville, OH; Jackson, OH; Ironton, OH; Franklin Furance, OH
O20100217000538 KY Part B Supplier - Clinic/Group Practice 6103968029 Receives reassigned benefits from 554 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory

Locations

613 23rd St
Ste 510
Ashland, KY 41101

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1720397409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2379",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411052379",
            "telephone_number": "606-408-2600",
            "fax_number": "606-408-2606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 23RD ST STE 105",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411012890",
            "telephone_number": "606-408-7500",
            "fax_number": "606-408-6600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Scioto Trl Ste 200",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "OH",
            "postal_code": "456622845",
            "country_code": "US",
            "telephone_number": "740-353-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KINGS DAUGHTERS MEDICAL SPECIALTIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-29",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "606-408-4401"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100140330",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Daughters Medical Specialties - Plastic & Reconstructive Surgeon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kings Daughters Medical Specialties - Plastic & Reconstructive Surgeon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashland, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.