Healthcare Provider Details

I. General information

NPI: 1245593946
Provider Name (Legal Business Name): ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 DIXIE HWY SUITE K
FT WRIGHT KY
41011-2792
US

IV. Provider business mailing address

560 S LOOP RD
EDGEWOOD KY
41017
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-3933
  • Fax: 513-793-3868
Mailing address:
  • Phone: 859-817-7500
  • Fax: 859-817-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANN MARIE REIS
Title or Position: MANAGER/CEO
Credential:
Phone: 859-817-7070