Healthcare Provider Details

I. General information

NPI: 1699770198
Provider Name (Legal Business Name): ORTHOPAEDIC SERVICES OF PADUCAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BROADWAY ST STE 2
PADUCAH KY
42001-7107
US

IV. Provider business mailing address

PO BOX 50591
NASHVILLE TN
37205-0591
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-0948
  • Fax: 270-575-3369
Mailing address:
  • Phone: 615-604-3068
  • Fax: 615-298-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. SHANNON B GARRETT
Title or Position: PRESIDENT
Credential:
Phone: 270-444-0948