Provider Demographics
NPI:1598777468
Name:ORTHOPAEDIC SURGICAL SPECIALISTS,PSC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGICAL SPECIALISTS,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PSC
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:POLIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-683-3538
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3538
Mailing Address - Fax:270-683-9494
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:SUITE 201B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3538
Practice Address - Fax:270-683-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65900755Medicaid
KY95900346Medicaid
KY95900346Medicaid
KY6075Medicare PIN
KY3880600001Medicare NSC