Premier Surgery Center of Louisville LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

300044 Issued in KY

Legal business name

PREMIER SURGERY CENTER OF LOUISVILLE LP

Practice address

2511 Terra Crossing Blvd
Louisville, KY 40245-5375

Phone

(502) 589-9488

Fax

(502) 254-3901

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Tiffany Brock

Title

Chief Administrative Officer

Phone

(502) 589-9488

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Premier Surgery Center of Louisville Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Listed as

Premier Surgery Center of Louisville LP Dba Premier Surgery Center of LouisvilleCCN 18C0001003

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571875200000",
    "number": "1740246792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 TERRA CROSSING BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402455375",
            "telephone_number": "502-589-9488",
            "fax_number": "502-254-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 TERRA CROSSING BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402455375",
            "telephone_number": "502-589-9488",
            "fax_number": "502-254-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SURGERY CENTER OF LOUISVILLE LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2019-10-24",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "502-589-9488"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "KY",
            "license": "300044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36000891",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Surgery Center of Louisville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Premier Home Care, Inc.
• Premier Imaging Solutions LLC
• Premier Mobile Therapy, PLLC
• Premier Rehabilitation and Medical Services
• Premier Respiratory Care LLC
• Premier Vision Center PLLC
• Premise Health of Tennessee Medical PC
• Premise Health of West Virginia Medical Medical Corporation
• Premise Health of West Virginia Medical Medical Corporation
• Premise Health of West Virginia Medical, Medical Corporation

• Ambulatory Surgical Clinic/Center in Louisville, KY
• Providers in Louisville, KY by specialty
• Ambulatory Surgical Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.