Organization
SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Active
Other names
ORTHOPEDIC INSTITUTE OF WESTERN KENTUCKY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS W DAVIS M.D. (PRESIDENT)
(618) 997-6800
Entity
Organization
Contact information
Practice address
3530 LONE OAK RD, STE A, PADUCAH, KY 42003-5752
(270) 554-0505
(270) 554-0905
Mailing address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
(618) 998-9124
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
36333
KY
332B00000X
Durable Medical Equipment & Medical Supplies
042617215
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100080520
—
KY
Enumeration date
08/29/2005
Last updated
01/10/2011
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