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Organization
SPORTS MEDICINE SURGICAL SPECIALISTS PLLC
Active
Organization
SPORTS MEDICINE SURGICAL SPECIALISTS PLLC
Active
Other names
Kentuckiana Foot and Ankle Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH WELLINGTON MYRICK DPM (SOLE OWNER)
(502) 721-8288
Entity
Organization
Contact information
Practice address
6400 DUTCHMANS PKWY STE 215, LOUISVILLE, KY 40205-3343
(502) 721-8288
(502) 721-8792
Mailing address
6400 DUTCHMANS PKWY, # 215, LOUISVILLE, KY 40205-3340
(502) 721-8288
(502) 721-8792
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100333220
—
KY
Enumeration date
11/05/2014
Last updated
12/05/2021
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