Healthcare Provider Details

I. General information

NPI: 1467596585
Provider Name (Legal Business Name): DUBIN ORTHOPAEDIC CENTRE, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N 12TH ST SUITE 100
MIDDLESBORO KY
40965-1835
US

IV. Provider business mailing address

705 N 12TH ST STE 100 PO BOX 2897
MIDDLESBORO KY
40965-1835
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-0050
  • Fax: 606-248-8711
Mailing address:
  • Phone: 606-248-0050
  • Fax: 606-248-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number25458
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA679
License Number StateKY

VIII. Authorized Official

Name: DR. RONALD S. DUBIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 606-248-0050