Healthcare Provider Details

I. General information

NPI: 1083622591
Provider Name (Legal Business Name): COMMONWEALTH ORTHOPAEDIC SURGEONS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NICHOLASVILLE RD STE 601
LEXINGTON KY
40503-1400
US

IV. Provider business mailing address

1780 NICHOLASVILLE RD STE 601
LEXINGTON KY
40503-1400
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-0124
  • Fax: 859-231-8667
Mailing address:
  • Phone: 859-253-0124
  • Fax: 859-231-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RONALD C BURGESS
Title or Position: PRESIDENT
Credential: MD
Phone: 859-253-0124