Healthcare Provider Details

I. General information

NPI: 1972501559
Provider Name (Legal Business Name): CENTER FOR ARTHRITIS & OSTEOPOROSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 WESTPORT RD SUITE 101
ELIZABETHTOWN KY
42701-2987
US

IV. Provider business mailing address

584 WESTPORT RD SUITE 101
ELIZABETHTOWN KY
42701-2987
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-2535
  • Fax: 270-769-9020
Mailing address:
  • Phone: 270-769-2535
  • Fax: 270-769-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number30757
License Number StateKY

VIII. Authorized Official

Name: DR. DAKSHA P MEHTA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 270-769-2535