Healthcare Provider Details

I. General information

NPI: 1265284806
Provider Name (Legal Business Name): SPINE AND ORTHOPEDIC SPECIALISTS OF KENTUCKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S 1ST ST STE 300
LOUISVILLE KY
40202-5302
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 202
WEST PALM BEACH FL
33409-6507
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax: 561-600-8705
Mailing address:
  • Phone: 516-507-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE YANTZ
Title or Position: ASSISTANT ADMIN
Credential:
Phone: 516-507-0800