MEDICARE: KENTUCKY ORTHOPAEDICS & SPINE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285308668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY ORTHOPAEDICS & SPINE PLLC

Provider Business Mailing Address
First Line	:	404 SHOPPERS DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1301
Country	:	US
Telephone Number	:	859-737-5333
Fax Number	:	859-737-0070

Provider Business Practice Location Address
First Line	:	235 BOGGS LN STE 7
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3325
Country	:	US
Telephone Number	:	859-625-9959
Fax Number	:	859-625-9958

Authorized Official
Title or Position	:	CREDENTIALING AGENT
Name	:	JOY CLEVENGER
Credential	:
Telephone Number	:	502-523-6695

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	03/23/2026

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