Basic Information
| Provider Information | |||||||||
| NPI: | 1124136254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 KRESGE WAY | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022122663 | ||||||||
| FaxNumber: | 5022122004 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 KRESGE WAY | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022122663 | ||||||||
| FaxNumber: | 5022122004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | GROSSFELD | ||||||||
| AuthorizedOfficialFirstName: | STACIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5022122663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 33575 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.