Healthcare Provider Details

I. General information

NPI: 1902850654
Provider Name (Legal Business Name): CENTER FOR ORTHOPAEDIC SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MCCOY AVENUE SUITE 442
MADISONVILLE KY
42431-2963
US

IV. Provider business mailing address

44 MCCOY AVENUE SUITE 442
MADISONVILLE KY
42431-2963
US

V. Phone/Fax

Practice location:
  • Phone: 270-824-6655
  • Fax: 270-824-6629
Mailing address:
  • Phone: 270-824-6655
  • Fax: 270-824-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number19218 (KBML-DONLEY)
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES M DONLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 270-824-6655