| Medical Laser Center Llc | |
|
133 Plaza Dr Suite 3 Berea KY 40403-2087 | |
| (859) 986-1370 | |
| (859) 986-1374 |
| Full Name | Medical Laser Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 133 Plaza Dr, Berea, Kentucky |
| Authorized Official Name and Position | Nawar Soda (OWNER) |
| Authorized Official Contact | 8599861370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Laser Center Llc 133 Plaza Dr Suite 3 Berea KY 40403-2087 Ph: (859) 986-1370 | Medical Laser Center Llc 133 Plaza Dr Suite 3 Berea KY 40403-2087 Ph: (859) 986-1370 |
| NPI Number | 1649401563 |
|---|---|
| Provider Enumeration Date | 07/28/2009 |
| Last Update Date | 10/31/2024 |
| Medicare PECOS PAC ID | 9830238823 |
|---|---|
| Medicare Enrollment ID | O20091204000183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649401563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Thomas W Fowles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285679100 PECOS PAC ID: 7810928058 Enrollment ID: I20050826000495 |
| Provider Name | Nawar Soda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083812598 PECOS PAC ID: 5698715092 Enrollment ID: I20080122000005 |
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