Provider Demographics
NPI:1881740843
Name:SOUTH CENTRAL KY ORTHOPEDICS PSC
Entity type:Organization
Organization Name:SOUTH CENTRAL KY ORTHOPEDICS PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-9390
Mailing Address - Street 1:106 COLUMNS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8068
Mailing Address - Country:US
Mailing Address - Phone:270-651-9390
Mailing Address - Fax:270-651-8698
Practice Address - Street 1:106 COLUMNS PLAZA DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-9390
Practice Address - Fax:270-651-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64205321Medicaid
KY7100399620Medicaid
KY64220510Medicaid
KY7100294280Medicaid
KY1972506145OtherNPI
KY1407859630OtherNPI
KY1134122336OtherNPI
KYCC1655OtherRAILROAD MEDICARE
KY64049240Medicaid
KYH60243Medicare UPIN
KY1134122336OtherNPI
KY1407859630OtherNPI