Healthcare Provider Details

I. General information

NPI: 1770571713
Provider Name (Legal Business Name): EASTERN KY BONE & JOINT SURGERY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N AUXIER AVE
PIKEVILLE KY
41501-9045
US

IV. Provider business mailing address

108 N AUXIER AVE
PIKEVILLE KY
41501-9045
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-4111
  • Fax: 606-432-4126
Mailing address:
  • Phone: 606-432-4111
  • Fax: 606-432-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES STEVEN SHOCKEY
Title or Position: PRESIDENT ORTHOPAEDIC SURGEON
Credential: M.D.
Phone: 606-432-4111