1508845868 NPI number — ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE

Table of content: (NPI 1508845868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508845868 NPI number — ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMONWEALTH ORTHOPAEDIC CENTERS PSC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508845868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 S LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-557-4270
Provider Business Mailing Address Fax Number:
513-557-3214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 SOUTH LOOP ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-0700
Provider Business Practice Location Address Fax Number:
859-301-0655
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REIS
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO/MANAGER
Authorized Official Telephone Number:
859-817-7070

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65942401 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8790057700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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