Healthcare Provider Details

I. General information

NPI: 1245589217
Provider Name (Legal Business Name): EXTREMITY CENTER OF KENTUCKIANA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EASTPOINT PKWY STE 560
LOUISVILLE KY
40223-4154
US

IV. Provider business mailing address

12418 LA GRANGE RD STE 145
LOUISVILLE KY
40245-2908
US

V. Phone/Fax

Practice location:
  • Phone: 502-365-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0834564
License Number StateKY

VIII. Authorized Official

Name: ROBERT HOBBS
Title or Position: PARTNER
Credential:
Phone: 502-365-4545