Provider Demographics
NPI:1265284806
Name:SPINE AND ORTHOPEDIC SPECIALISTS OF KENTUCKY PLLC
Entity type:Organization
Organization Name:SPINE AND ORTHOPEDIC SPECIALISTS OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-507-0800
Mailing Address - Street 1:2090 PALM BEACH LAKES BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6507
Mailing Address - Country:US
Mailing Address - Phone:516-507-0800
Mailing Address - Fax:
Practice Address - Street 1:222 S 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5302
Practice Address - Country:US
Practice Address - Phone:561-507-0800
Practice Address - Fax:561-600-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty