1598714560 NPI number — ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC

Table of content: (NPI 1598714560)

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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