MEDICARE: SPECIALTY ORTHOPAEDICS PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	32683	KY
2	213ES0103X	Foot & Ankle Surgery Podiatrist	00251	KY
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	207X00000X	Orthopaedic Surgery Physician	31883	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DE3727	OTHER	KY	GRP RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1129663	OTHER	KY	GRP PASSPORT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174526487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY ORTHOPAEDICS PSC

Provider Business Mailing Address
First Line	:	6400 DUTCHMANS PKWY
Second Line	:	STE 215
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3343
Country	:	US
Telephone Number	:	502-721-8288
Fax Number	:	502-721-8792

Provider Business Practice Location Address
First Line	:	6400 DUTCHMANS PKWY
Second Line	:	STE 215
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3343
Country	:	US
Telephone Number	:	502-721-8288
Fax Number	:	502-721-8792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS MATTHEW GABRIEL
Credential	:	MD
Telephone Number	:	502-721-8288

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/17/2016

Similar Medicare Providers

1023011442 — DR. THOMAS MATTHEW GABRIEL M.D.
Practice Location Address:

6400 DUTCHMANS PKWY , STE 215
LOUISVILLE, KY
40205-3343

Practice Phone: 502-721-8288
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1033112354 — DR. SHARI ROSENBERG GABRIEL M.D.
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1689700940 — ASSOCIATES IN PLASTIC SURGERY, PLLC
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1861752909 — DR. FRANK RYAN WERMELING MD
Practice Location Address:

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1689070559 — SPORTS MEDICINE SURGICAL SPECIALISTS PLLC
Practice Location Address:

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1194296400 — MS. ALISON KAY TEMPERO LCSW
Practice Location Address:

6400 DUTCHMANS PKWY STE 205
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Directions to “SPECIALTY ORTHOPAEDICS PSC ” Practice Location

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