Healthcare Provider Details

I. General information

NPI: 1023300191
Provider Name (Legal Business Name): WESTERN KENTUCKY ORTHOPAEDIC AND NEUROSURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NATCHEZ TRACE AVE SUITE 200
BOWLING GREEN KY
42103-7940
US

IV. Provider business mailing address

165 NATCHEZ TRACE AVE SUITE 100
BOWLING GREEN KY
42103-7940
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-7800
  • Fax: 270-843-0779
Mailing address:
  • Phone: 270-782-7800
  • Fax: 270-843-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SARAH BURGER
Title or Position: NETWORK ADMINISTRATOR
Credential:
Phone: 270-782-7800