MEDICARE: MARK A MYERS M.D.

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	32619	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122601	OTHER	KY	CHA
2	5134693001	OTHER	KY	CIGNA
3	5344332	OTHER	KY	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	PASSPORT ADVANTAGE	OTHER	KY	2434349000
6	000000041773	OTHER	KY	ANTHEM
7	000802487	OTHER	KY	HUMANA
8	1063266	OTHER	KY	PASSPORT HEALTH PLAN

General Provider Information

NPI Number	:	1467456855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A MYERS M.D.

Provider Business Mailing Address
First Line	:	18 VILLAGE PLAZA, PMB 136
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-1711
Country	:	US
Telephone Number	:	502-633-0192
Fax Number	:	502-633-4164

Provider Business Practice Location Address
First Line	:	1741 MIDLAND TRL
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-1711
Country	:	US
Telephone Number	:	502-633-0192
Fax Number	:	502-633-4164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/19/2019

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Directions to “ MARK A MYERS M.D.” Practice Location

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