Healthcare Provider Details

I. General information

NPI: 1598777468
Provider Name (Legal Business Name): ORTHOPAEDIC SURGICAL SPECIALISTS,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE SUITE 201B
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E PARRISH AVE SUITE 201B
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3538
  • Fax: 270-683-9494
Mailing address:
  • Phone: 270-683-3538
  • Fax: 270-683-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LEO POLIO
Title or Position: PRESIDENT OF PSC
Credential: M.D.
Phone: 270-683-3538