Provider Demographics
NPI:1508845868
Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:COMMONWEALTH ORTHOPAEDIC CENTERS PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
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 RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:513-557-4270
Mailing Address - Fax:513-557-3214
Practice Address - Street 1:560 SOUTH LOOP ROAD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5102
Practice Address - Country:US
Practice Address - Phone:859-301-0700
Practice Address - Fax:859-301-0655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOCINCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-13
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942401Medicaid
KY8790057700Medicaid
KY8790057700Medicaid
KY0428850003Medicare NSC
KY9229Medicare PIN