=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235232315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPALACHIAN ORTHOPEDIC & SPINE CTR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MEDICAL CENTER DR #2-I
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-487-0888
-----------------------------------------------------
Fax | 606-487-0890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MEDICAL CENTER DR #2-I
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-487-0888
-----------------------------------------------------
Fax | 606-487-0890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD OWNER SOLO PRACTICE
-----------------------------------------------------
Name | MR. MUKUT SHARMA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 606-487-0888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 34715
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------