Provider Demographics
NPI:1750312187
Name:WEST KENTUCKY ORTHOPAEDICS AND SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:WEST KENTUCKY ORTHOPAEDICS AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-889-0701
Mailing Address - Street 1:105 KEETON DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8756
Mailing Address - Country:US
Mailing Address - Phone:270-889-0701
Mailing Address - Fax:270-889-0556
Practice Address - Street 1:105 KEETON DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8756
Practice Address - Country:US
Practice Address - Phone:270-889-0701
Practice Address - Fax:270-889-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
=========OtherEIN
9283Medicare ID - Type Unspecified