Provider Demographics
NPI:1639145220
Name:THE PADUCAH ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:THE PADUCAH ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-1638
Mailing Address - Street 1:PO BOX 7099
Mailing Address - Street 2:1532 LONE OAK RD STE 310
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002
Mailing Address - Country:US
Mailing Address - Phone:270-442-1638
Mailing Address - Fax:270-575-8555
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:STE 310
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42002
Practice Address - Country:US
Practice Address - Phone:270-442-1638
Practice Address - Fax:270-575-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000200170OtherBC/BS OF KY
KY65902801Medicaid
90001064OtherBC/BS OF IL
90001064OtherBC/BS OF IL
KY65902801Medicaid
2819Medicare PIN