Provider Demographics
NPI:1699770198
Name:ORTHOPAEDIC SERVICES OF PADUCAH INC
Entity type:Organization
Organization Name:ORTHOPAEDIC SERVICES OF PADUCAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-0948
Mailing Address - Street 1:PO BOX 50591
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-0591
Mailing Address - Country:US
Mailing Address - Phone:615-604-3068
Mailing Address - Fax:615-298-3762
Practice Address - Street 1:2021 BROADWAY ST
Practice Address - Street 2:STE 2
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7107
Practice Address - Country:US
Practice Address - Phone:270-444-0948
Practice Address - Fax:270-575-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90140732Medicaid
KY0140240001Medicare ID - Type Unspecified