Provider Demographics
NPI:1083185938
Name:KENTUCKY ORTHOPAEDICS & SPINE PLLC
Entity Type:Organization
Organization Name:KENTUCKY ORTHOPAEDICS & SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-737-5333
Mailing Address - Street 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1378
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:404 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1378
Practice Address - Country:US
Practice Address - Phone:859-737-5333
Practice Address - Fax:859-737-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100598040Medicaid
KY7100598050Medicaid
KY7100737620Medicaid