Healthcare Provider Details

I. General information

NPI: 1750312187
Provider Name (Legal Business Name): WEST KENTUCKY ORTHOPAEDICS AND SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 KEETON DR
HOPKINSVILLE KY
42240-8756
US

IV. Provider business mailing address

105 KEETON DR
HOPKINSVILLE KY
42240-8756
US

V. Phone/Fax

Practice location:
  • Phone: 270-889-0701
  • Fax: 270-889-0556
Mailing address:
  • Phone: 270-889-0701
  • Fax: 270-889-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID P BEALLE
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 270-889-0701