Provider Demographics
NPI:1023040169
Name:RAYMOND G SHEA MD PSC
Entity Type:Organization
Organization Name:RAYMOND G SHEA MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-587-8222
Mailing Address - Street 1:201 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-587-8222
Mailing Address - Fax:502-587-0860
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-587-8222
Practice Address - Fax:502-587-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16187207X00000X
KY22228207X00000X
KY30060207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty