Provider Demographics
NPI:1467596585
Name:DUBIN ORTHOPAEDIC CENTRE, P.S.C.
Entity Type:Organization
Organization Name:DUBIN ORTHOPAEDIC CENTRE, P.S.C.
Other - Org Name:KENTUCKY ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-0050
Mailing Address - Street 1:705 N 12TH ST STE 100
Mailing Address - Street 2:PO BOX 2897
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1835
Mailing Address - Country:US
Mailing Address - Phone:606-248-0050
Mailing Address - Fax:606-248-8711
Practice Address - Street 1:705 N 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1835
Practice Address - Country:US
Practice Address - Phone:606-248-0050
Practice Address - Fax:606-248-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25458261Q00000X
KYPA679363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1359761OtherUMWA
KY163844200OtherDEPT OF LABOR
KY085617OtherVA BCBS
KY50009243OtherPHP
KY95001780Medicaid
KY000000505007OtherA. JONES, PA-C IND ID#
KY6410111OtherVA MEDICAID
KY000000048909OtherR. DUBIN, M.D. IND ID#
KY90004839OtherKY MEDICAID DME
KY64254584Medicaid
KY000000059556OtherBCBS GRP #
KY00196OtherMEDICARE GROUP#
KY00196002OtherMEDICARE PIN #
KY4409001OtherTN MEDICAID
KY0067174OtherTN BCBS
KY1467596585OtherMEDICARE RAILROAD GROUP NPI
KY200033474OtherRAILROAD MEDICARE
KY00196002OtherMEDICARE PIN #
KY1314906Medicare ID - Type UnspecifiedAMY JONES, PA-C
KY4148450001Medicare NSC
KY000000059556OtherBCBS GRP #
KY1446802Medicare ID - Type UnspecifiedRONALD S. DUBIN, M.D.