Provider Demographics
NPI:1003013871
Name:DUBIN ORTHOPAEDIC CENTRE, PSC
Entity Type:Organization
Organization Name:DUBIN ORTHOPAEDIC CENTRE, PSC
Other - Org Name:KENTUCKY ORTHOPAEDIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SANFORD
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-0050
Mailing Address - Street 1:705 N 12TH ST STE 100
Mailing Address - Street 2:PO BOX 2897
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1835
Mailing Address - Country:US
Mailing Address - Phone:606-248-0050
Mailing Address - Fax:606-248-8711
Practice Address - Street 1:705 N 12TH ST
Practice Address - Street 2:STE 100
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1835
Practice Address - Country:US
Practice Address - Phone:606-248-0050
Practice Address - Fax:606-248-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25458335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00196002OtherMEDICARE PIN# DR DUBIN
KY90004839OtherKY MEDICAID DME
KY000000059556-BCBSOtherBCBS GROUP #
KY000000048909-BCBSOtherRONALD S. DUBIN, M.D.
KY000000505007-BCBSOtherAMY L. JONES, PA-C
KY95001780Medicaid
KY4409001OtherRAILROAD MEDICARE
KY64254584Medicaid
KY64254584Medicaid
KY000000059556-BCBSOtherBCBS GROUP #
KY000000048909-BCBSOtherRONALD S. DUBIN, M.D.
KY00196002OtherMEDICARE PIN# DR DUBIN
KY00196001Medicare ID - Type UnspecifiedAMY L. JONES, PA-C
KY95001780Medicaid