Organization
SPECIALTY ORTHOPAEDICS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MATTHEW GABRIEL MD (PRESIDENT)
(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, STE 215, LOUISVILLE, KY 40205-3343
(502) 721-8288
(502) 721-8792
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
31883
KY
207XS0106X
Orthopaedic Hand Surgery Physician
32683
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
00251
KY
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1129663
GRP PASSPORT
KY
05
—
65915308
—
KY
01
—
80900293
GRP MEDICAID PODIATRY
KY
01
—
DE3727
GRP RAILROAD MEDICARE
KY
Enumeration date
05/31/2005
Last updated
08/17/2016
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