Provider Demographics
NPI:1023341658
Name:ORTHO KENTUCKY PLLC
Entity type:Organization
Organization Name:ORTHO KENTUCKY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEGNORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-3481
Mailing Address - Street 1:1780 NICHOLASVILLE RD
Mailing Address - Street 2:STE 501
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1400
Mailing Address - Country:US
Mailing Address - Phone:859-278-3481
Mailing Address - Fax:859-277-7365
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 501
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-278-3481
Practice Address - Fax:859-277-7365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO KENTUCKY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-15
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0106X, 207XX0004X, 207X00000X
KYPA1084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100107610Medicaid
KYP100016344Medicare PIN