Provider Demographics
NPI:1871675991
Name:ORTHO KENTUCKY DBA KENTUCKY BONE & JOINT SURGEONS
Entity Type:Organization
Organization Name:ORTHO KENTUCKY DBA KENTUCKY BONE & JOINT SURGEONS
Other - Org Name:KOOROS SAJADI PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOOROS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-5008
Mailing Address - Street 1:230 FOUNTAIN CT
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1895
Mailing Address - Country:US
Mailing Address - Phone:859-276-5008
Mailing Address - Fax:859-278-6401
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:SUITE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1895
Practice Address - Country:US
Practice Address - Phone:859-276-5008
Practice Address - Fax:859-278-6401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO KENTUCKY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19960207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199607Medicaid
KY1344Medicare PIN
KY64199607Medicaid