Provider Demographics
NPI:1679819353
Name:KENTUCKY OSTEO RELIEF INSTITUTE PSC
Entity Type:Organization
Organization Name:KENTUCKY OSTEO RELIEF INSTITUTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCATENA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-446-5603
Mailing Address - Street 1:1019 MAJESTIC DR STE 270
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1897
Mailing Address - Country:US
Mailing Address - Phone:859-446-5603
Mailing Address - Fax:859-223-0494
Practice Address - Street 1:1019 MAJESTIC DR STE 270
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1897
Practice Address - Country:US
Practice Address - Phone:859-446-5603
Practice Address - Fax:859-223-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6760500001Medicare NSC
KYK080660Medicare PIN