=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508937046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCENSION ORTHOPAEDICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S 8TH ST STE 378W
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42071-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-753-5073
-----------------------------------------------------
Fax | 270-767-3620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S 8TH ST STE 378W
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42071-2408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-753-5073
-----------------------------------------------------
Fax | 270-767-3620
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BENNIE M FULBRIGHT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-753-5073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 39165
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------