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General NPI Number Information
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NPI Number | 1174526487
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPAEDICS PSC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 6400 DUTCHMANS PKWY STE 215
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City | LOUISVILLE
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State | KY
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Zip | 40205-3343
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Country | US
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Telephone | 502-721-8288
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Fax | 502-721-8792
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Provider Business Mailing Address
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Address Line | 6400 DUTCHMANS PKWY STE 215
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City | LOUISVILLE
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State | KY
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Zip | 40205-3343
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Country | US
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Telephone | 502-721-8288
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Fax | 502-721-8792
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS MATTHEW GABRIEL
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Credential | MD
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Telephone | 502-721-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 32683
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00251
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 31883
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License Number State | KY
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