Healthcare Provider Details

I. General information

NPI: 1174526487
Provider Name (Legal Business Name): SPECIALTY ORTHOPAEDICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 DUTCHMANS PKWY STE 215
LOUISVILLE KY
40205-3343
US

IV. Provider business mailing address

6400 DUTCHMANS PKWY STE 215
LOUISVILLE KY
40205-3343
US

V. Phone/Fax

Practice location:
  • Phone: 502-721-8288
  • Fax: 502-721-8792
Mailing address:
  • Phone: 502-721-8288
  • Fax: 502-721-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number32683
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00251
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number31883
License Number StateKY

VIII. Authorized Official

Name: DR. THOMAS MATTHEW GABRIEL
Title or Position: PRESIDENT
Credential: MD
Phone: 502-721-8288