MEDICARE: ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE OF KY PLLC

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB5273	OTHER	KY	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000311396	OTHER	KY	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992832679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ORTHOPAEDICS AND SPORTS MEDICINE OF KY PLLC

Provider Business Mailing Address
First Line	:	789 EASTERN BYP STE 5
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2407
Country	:	US
Telephone Number	:	859-624-4110
Fax Number	:	859-624-1968

Provider Business Practice Location Address
First Line	:	789 EASTERN BYP STE 5
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2407
Country	:	US
Telephone Number	:	859-624-4110
Fax Number	:	859-624-1968

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. THOMAS D CERVONI
Credential	:	MD
Telephone Number	:	859-624-4110

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	06/11/2010

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