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General NPI Number Information
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NPI Number | 1326682733
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Entity Type | Organization
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Legal Business Name | FORTIS ORTHOPAEDIC AND SARCOMA GROUP PLLC
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 9407 WESTPORT RD STE 110
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City | LOUISVILLE
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State | KY
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Zip | 40241-2315
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Country | US
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Telephone | 502-916-6163
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Fax | 502-996-8414
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Provider Business Mailing Address
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Address Line | PO BOX 311
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City | PEWEE VALLEY
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State | KY
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Zip | 40056-0311
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Country | US
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Telephone | 502-916-6163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN L PRICE
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Credential | MD
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Telephone | 502-916-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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