Provider Demographics
NPI:1386806735
Name:CENTRAL KENTUCKY SPINE SURGERY, PLLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY SPINE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:KNETSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-239-9680
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1812
Mailing Address - Country:US
Mailing Address - Phone:859-239-9680
Mailing Address - Fax:
Practice Address - Street 1:236 W MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1812
Practice Address - Country:US
Practice Address - Phone:859-239-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42368207XS0117X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6204140001Medicare NSC