MEDICARE: RIVER CITY ORTHOPAEDIC SURGEONS, PSC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CL1931	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1083879	OTHER	KY	PASSPORT
2	3435655000	OTHER	KY	PASSPORT ADVANTAGE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881757425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY ORTHOPAEDIC SURGEONS, PSC

Provider Business Mailing Address
First Line	:	9300 STONESTREET RD
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2876
Country	:	US
Telephone Number	:	502-935-8061
Fax Number	:	502-933-7010

Provider Business Practice Location Address
First Line	:	9300 STONESTREET RD
Second Line	:	SUITE 200
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-2876
Country	:	US
Telephone Number	:	502-935-8061
Fax Number	:	502-933-7010

Authorized Official
Title or Position	:	CORPORATE OFFICER
Name	:	DAVID P ROUBEN
Credential	:	MD
Telephone Number	:	502-935-8061

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	10/21/2011

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Directions to “RIVER CITY ORTHOPAEDIC SURGEONS, PSC ” Practice Location

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