1598714560 NPI number — ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598714560 NPI number — ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
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:
ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Provider Other Organization Name Type Code:
5
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:
1598714560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2022
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:
859-301-2663
Provider Business Mailing Address Fax Number:
859-301-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 S LOOP RD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-2663
Provider Business Practice Location Address Fax Number:
859-301-0655
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 80900186 . This is a "MEDICAID PODIATRIST" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100185740 . This is a "MEDICAID NURSE PRACTITIONER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 90008962 . This is a "MEDICAID DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9590071800 . This is a "MEDICAID PHYSICIAN ASSISTANT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100147130 . This is a "MEDICAID PHYSICAL THERAPIST" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65927881 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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