Provider Demographics
NPI:1396960233
Name:WESTERN KENTUCKY ORTHOPAEDIC & NEUROSURGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:WESTERN KENTUCKY ORTHOPAEDIC & NEUROSURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-782-7800
Mailing Address - Street 1:165 NATCHEZ TRACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103
Mailing Address - Country:US
Mailing Address - Phone:270-782-7800
Mailing Address - Fax:270-843-0779
Practice Address - Street 1:165 NATCHEZ TRACE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-782-7800
Practice Address - Fax:270-843-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207T00000X, 207X00000X
363A00000X, 261Q00000X, 261QP2000X, 261QX0100X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100241800Medicaid
KY000000060685OtherANTHEM GROUP
KY6978Medicare ID - Type UnspecifiedSCOTTSVILLE MEDICARE
KY000000060685OtherANTHEM GROUP
KY6742Medicare ID - Type UnspecifiedFRANKLIN MEDICARE
KY3051Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER