Healthcare Provider Details

I. General information

NPI: 1033288717
Provider Name (Legal Business Name): RIVER CITIES BONE AND JOINT CENTRE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASHLAND DR SUITE 103
ASHLAND KY
41101-7057
US

IV. Provider business mailing address

1000 ASHLAND DR SUITE 103
ASHLAND KY
41101-7057
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0097
  • Fax:
Mailing address:
  • Phone: 606-324-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LEITH
Title or Position: OWNER
Credential: MD
Phone: 606-324-0097