Healthcare Provider Details

I. General information

NPI: 1447598586
Provider Name (Legal Business Name): ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BARNES RD
WILLIAMSTOWN KY
41097
US

IV. Provider business mailing address

560 S LOOP ROAD
EDGEWOOD KY
41017-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2663
  • Fax: 859-301-0655
Mailing address:
  • Phone: 859-817-7500
  • Fax: 859-817-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. JOANN M. REIS
Title or Position: CEO
Credential:
Phone: 859-817-7070