=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073633400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUISVILLE ORTHOPAEDIC SURGERY CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 01/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4130 DUTCHMANS LN SUITE 200
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-2804
-----------------------------------------------------
Fax | 502-238-1285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4130 DUTCHMANS LN SUITE 200
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-897-2804
-----------------------------------------------------
Fax | 502-238-1285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | NORMAN V LEWIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-897-1794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------