MEDICARE: RIVER CITY ORTHOPAEDIC SURGEONS 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

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

General Provider Information

NPI Number	:	1730182445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY ORTHOPAEDIC SURGEONS PSC

Provider Business Mailing Address
First Line	:	9300 STONESTREET RD
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2876
Country	:	US
Telephone Number	:	502-271-4150
Fax Number	:	502-933-1024

Provider Business Practice Location Address
First Line	:	9300 STONESTREET RD
Second Line	:	STE 100
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2876
Country	:	US
Telephone Number	:	502-271-4150
Fax Number	:	502-933-1024

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-403-1401

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/07/2009

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