1962735621 NPI number — ORTHO KENTUCKY DBA KENTUCKY BONE & JOINT SURGEONS

Table of content: (NPI 1962735621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962735621 NPI number — ORTHO KENTUCKY DBA KENTUCKY BONE & JOINT SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO KENTUCKY DBA KENTUCKY BONE & JOINT SURGEONS
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:
KENTUCKY BONE AND JOINT SURGEONS
Provider Other Organization Name Type Code:
3
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:
1962735621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 FOUNTAIN CT STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-276-5008
Provider Business Mailing Address Fax Number:
859-278-6401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 FOUNTAIN CT STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-276-5008
Provider Business Practice Location Address Fax Number:
859-278-6401
Provider Enumeration Date:
09/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAJADI
Authorized Official First Name:
KAVEH
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
859-276-5008

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA1125 , 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: 7100232300 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100104260 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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