Provider Demographics
NPI:1396156972
Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Entity type:Organization
Organization Name:ORTHOCINCY ORTHOPAEDICS & SPORTS MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:859-817-7070
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-301-0655
Practice Address - Street 1:8726 US 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-301-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207QS0010X, 207R00000X, 207RM1200X, 207XS0106X, 213E00000X, 225100000X, 332B00000X, 363AM0700X, 363L00000X, 363LF0000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9590071800OtherMEDICAID PHYSICIAN ASSISTANT
KY7100185740OtherMEDICAID NURSE PRACTITIONER
KY7100147130OtherMEDICAID PHYSICAL THERAPIST
KY90008962OtherMEDICAID DME
KY65927881 GROUPMedicaid
KY80900186OtherMEDICAID PODIATRIST
KY9590071800OtherMEDICAID PHYSICIAN ASSISTANT
KY80900186OtherMEDICAID PODIATRIST
KY90008962OtherMEDICAID DME
KYCB8861 PALMETTO GBAMedicare PIN
KY0428850005Medicare NSC
OHH177740 OHIO PTANMedicare PIN