Healthcare Provider Details

I. General information

NPI: 1447236237
Provider Name (Legal Business Name): SPINE SURGERY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E GRAY ST SUITE 601
LOUISVILLE KY
40202-3902
US

IV. Provider business mailing address

210 E GRAY ST SUITE 601
LOUISVILLE KY
40202-3902
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-2300
  • Fax: 502-584-2726
Mailing address:
  • Phone: 502-585-2300
  • Fax: 502-584-2726

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: MRS. LINETTE M GADWAH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 502-585-2300