Provider Demographics
NPI:1598816209
Name:KENTUCKY ORTHOPEDIC SPECIALISTS PLLC
Entity type:Organization
Organization Name:KENTUCKY ORTHOPEDIC SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:O
Authorized Official - Last Name:DRIPCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-367-1744
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:STE 406
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-367-1744
Mailing Address - Fax:
Practice Address - Street 1:4402 CHURCHMAN AVENUE
Practice Address - Street 2:SUITE 406
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215
Practice Address - Country:US
Practice Address - Phone:502-367-1744
Practice Address - Fax:502-367-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF05506Medicare UPIN