Basic Information
| Provider Information | |||||||||
| NPI: | 1013317981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN KENTUCKY ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 NATCHEZ TRACE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421037947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707827800 | ||||||||
| FaxNumber: | 2708430779 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 N RACE ST | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421413465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706292780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2014 | ||||||||
| LastUpdateDate: | 01/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2707827800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.