Basic Information
| Provider Information | |||||||||
| NPI: | 1548498454 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EROMO | ||||||||
| FirstName: | ERSNO | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | STE #900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025847525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | STE #900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025847525 | ||||||||
| FaxNumber: | 5025846851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 238499 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | TP298 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XS0117X | 43786 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 118050 | 01 | KY | SIHO- NORTON LEATHERMAN SPINE CENTER | OTHER | 7100130210 | 05 | KY | MEDICAID | 118050 | 01 | NLS/SIHO | OTHER | 9567569 | 01 | KY | AETNA- NORTON LEATHERMAN SPINE CENTER | OTHER | 000052155W | 01 | KY | HUMANA- NORTON LEATHERMAN SPINE CENTER | OTHER | 50024957 | 01 | NLS/PHP | OTHER | 50024957 | 01 | KY | PASPORT- NORTON LEATHERMAN SPINE CENTER | OTHER | 000000675679 | 01 | NLS/ANTHEM | OTHER | 200993270 | 05 | IN | MEDICAID | 675679 | 01 | KY | ANTHEM- NORTON LEATHERMAN SPINE CENTER | OTHER |