Provider Demographics
NPI:1770782104
Name:PURCHASE REGIONAL ORTHOPAEDICS PSC
Entity type:Organization
Organization Name:PURCHASE REGIONAL ORTHOPAEDICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-251-8114
Mailing Address - Street 1:1029 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-251-8114
Mailing Address - Fax:270-251-8115
Practice Address - Street 1:1029 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 406
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1189
Practice Address - Country:US
Practice Address - Phone:270-251-8114
Practice Address - Fax:270-251-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03053207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100026150Medicaid
KY00364Medicare PIN