Healthcare Provider Details

I. General information

NPI: 1154572022
Provider Name (Legal Business Name): ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 CHANCELLOR DR
CRESTVIEW HILLS KY
41017
US

IV. Provider business mailing address

560 SOUTH LOOP ROAD
EDGEWOOD KY
41017-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-4200
  • Fax: 859-426-4206
Mailing address:
  • Phone: 859-817-7070
  • Fax: 859-817-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number28345
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOANN M. REIS
Title or Position: EXECUTIVE OFFICER
Credential: CEO
Phone: 859-817-7070