Provider Demographics
NPI:1295759579
Name:KENTUCKY ORTHOPAEDIC AND HAND SURGEONS, PSC
Entity type:Organization
Organization Name:KENTUCKY ORTHOPAEDIC AND HAND SURGEONS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-278-2776
Mailing Address - Street 1:PO BOX 890437
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0437
Mailing Address - Country:US
Mailing Address - Phone:859-278-3481
Mailing Address - Fax:859-275-1647
Practice Address - Street 1:1780 NICHOLASVILLE RAOD
Practice Address - Street 2:STE 501
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-3481
Practice Address - Fax:859-275-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000109035OtherBLUE CROSS BLUE SHIELD
KY90340340Medicaid
KY90340340Medicaid