Healthcare Provider Details

I. General information

NPI: 1881740843
Provider Name (Legal Business Name): SOUTH CENTRAL KY ORTHOPEDICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 COLUMNS PLAZA DR
GLASGOW KY
42141
US

IV. Provider business mailing address

106 COLUMNS PLAZA DR
GLASGOW KY
42141-8068
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9390
  • Fax: 270-651-8698
Mailing address:
  • Phone: 270-651-9390
  • Fax: 270-651-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-651-9390