MEDICARE: DR. JAMES THOMAS BILBO MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	24525	KY
2	207X00000X	Orthopaedic Surgery Physician	24525	KY

General Provider Information

NPI Number	:	1841295656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THOMAS BILBO MD

Provider Business Mailing Address
First Line	:	560 S LOOP RD
Second Line	:
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-3405
Country	:	US
Telephone Number	:	859-301-2663
Fax Number	:	859-301-0655

Provider Business Practice Location Address
First Line	:	2626 ALEXANDRIA PIKE STE 100
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-1530
Country	:	US
Telephone Number	:	859-301-2663
Fax Number	:	859-817-7848

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2021

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