Provider Demographics
NPI:1902850654
Name:CENTER FOR ORTHOPAEDIC SERVICES, PSC
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPAEDIC SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-824-6655
Mailing Address - Street 1:44 MCCOY AVENUE
Mailing Address - Street 2:SUITE 442
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2963
Mailing Address - Country:US
Mailing Address - Phone:270-824-6655
Mailing Address - Fax:270-824-6629
Practice Address - Street 1:44 MCCOY AVENUE
Practice Address - Street 2:SUITE 442
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2963
Practice Address - Country:US
Practice Address - Phone:270-824-6655
Practice Address - Fax:270-824-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X, 246ZS0410X, 363LF0000X
KY19218 (KBML-DONLEY)332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000356349OtherBCBS
KY7100142090OtherKY MEDICAID DME #
KY7100170840Medicaid
KY6594298900Medicaid
KY000000356349OtherBCBS
KYDD0727Medicare PIN
KY9513Medicare PIN