Provider Demographics
NPI:1083622591
Name:COMMONWEALTH ORTHOPAEDIC SURGEONS PSC
Entity Type:Organization
Organization Name:COMMONWEALTH ORTHOPAEDIC SURGEONS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-253-0124
Mailing Address - Street 1:1780 NICHOLASVILLE RD
Mailing Address - Street 2:STE 601
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1400
Mailing Address - Country:US
Mailing Address - Phone:859-253-0124
Mailing Address - Fax:859-231-8667
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 601
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-253-0124
Practice Address - Fax:859-231-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65909236Medicaid
0282Medicare PIN
KY65909236Medicaid