Unknown Individual – Surgery Physician, NPI 1104893940

Unknown Individual is a healthcare provider. based in Versailles, Kentucky. specializing in Surgery Physician. They hold a License No. KY18300 (KY). The NPI Number for Unknown Individual is 1104893940

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104893940
Phone
(859) 873-8301
Address
360 AMSDEN AVE
Deactivation Date
25 October 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Bluegrass Community Hospital, 360, Amsden Avenue, Versailles, Woodford County, Kentucky, 40383, United States

    SUITE 302

    VERSAILLES, KY 40383

    Phone: (859) 873-8301

    Fax: (859) 873-4242

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 40383)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1104893940 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Surgery Physician in the directory — Clinical services aligned with this taxonomy classification.
Where in Kentucky is Unknown Individual registered?
Use Versailles, Kentucky as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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