Provider Demographics
NPI:1467568162
Name:THE LOUISVILLE BONE & JOINT CENTER
Entity Type:Organization
Organization Name:THE LOUISVILLE BONE & JOINT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALILY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-562-6021
Mailing Address - Street 1:PO BOX 635191
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0043
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 701
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-562-6021
Practice Address - Fax:502-562-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4059OtherRR MEDICARE
KY50001642OtherPASSPORT
KY2443212000OtherPASSPORT ADVANTAGE
KY7100037410Medicaid
IN200443290AMedicaid
KY50001642OtherPASSPORT