Provider Demographics
NPI:1447598586
Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Entity Type:Organization
Organization Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-817-7070
Mailing Address - Street 1:560 S LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-8010
Mailing Address - Country:US
Mailing Address - Phone:859-817-7500
Mailing Address - Fax:859-817-7851
Practice Address - Street 1:238 BARNES RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-301-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207X00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0428850005Medicare NSC
KY0428850003Medicare NSC
KY0428850001Medicare NSC
KY0428850007Medicare NSC
KY3892Medicare PIN