Provider Demographics
NPI:1730182445
Name:RIVER CITY ORTHOPAEDIC SURGEONS PSC
Entity type:Organization
Organization Name:RIVER CITY ORTHOPAEDIC SURGEONS PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-403-1401
Mailing Address - Street 1:9300 STONESTREET RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2876
Mailing Address - Country:US
Mailing Address - Phone:502-271-4150
Mailing Address - Fax:502-933-1024
Practice Address - Street 1:9300 STONESTREET RD
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2876
Practice Address - Country:US
Practice Address - Phone:502-271-4150
Practice Address - Fax:502-933-1024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER CITY ORTHOPAEDIC SURGEONS PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65922528Medicaid
KY9031Medicare PIN