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General NPI Number Information
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NPI Number | 1396935854
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Entity Type | Organization
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Legal Business Name | KNOX ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 1375 YAUGER RD SUITE A
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City | MOUNT VERNON
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State | OH
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Zip | 43050-8939
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Country | US
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Telephone | 740-393-2226
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Fax | 740-393-2220
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | MOUNT VERNON
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State | OH
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Zip | 43050-0487
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Country | US
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Telephone | 740-393-2226
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Fax | 740-393-2220
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Authorized Official
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Title or Position | PRESIDENT, ORTHOPEDIC SURGERY
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Name | DR. KENNETH H. DOOLITTLE II
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Credential | M.D.
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Telephone | 740-393-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35-053777
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License Number State | OH
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