SPORTS MEDICINE SURGICAL SPECIALISTS PLLC NPI 1689070559

NPI Information

NPI: 1689070559
Provider Name: SPORTS MEDICINE SURGICAL SPECIALISTS PLLC

Doing Business As: KENTUCKIANA FOOT AND ANKLE SPORTS MEDICINE

Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
6400 DUTCHMANS PKWY STE 215
LOUISVILLE, KY
ZIP 40205
Phone: (502) 721-8288
Get Directions

SPORTS MEDICINE SURGICAL SPECIALISTS PLLC is a foot and ankle surgery podiatrist in Louisville, KY. SPORTS MEDICINE SURGICAL SPECIALISTS PLLC NPI is 1689070559. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Kentuckiana Foot And Ankle Sports Medicine.

The provider's business location address is:

6400 DUTCHMANS PKWY STE 215
LOUISVILLE, KY
ZIP 40205-343
Phone: (502) 721-8288
Fax: (502) 721-8792

The provider's authorized official is Keith Wellington Myrick .
The authorized official title is Sole Owner and has the following contact phone number (502) 721-8288.

The enumeration date for this NPI number is 11/5/2014 and was last updated on 12/5/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery			Yes
2	332B00000X	Durable Medical Equipment & Medical Supplies				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7100333220	MEDICAID	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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