Organization
SPINE INSTITUTE PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINA G KOCHERT CCP (BUSINESS OFFICE MANAGER)
(502) 584-8002
Entity
Organization
Contact information
Practice address
210 E GRAY ST, # 900, LOUISVILLE, KY 40202
(502) 584-7525
(502) 589-0849
Mailing address
210 E GRAY ST, # 900, LOUISVILLE, KY 40202
(502) 584-7525
(502) 589-0849
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100020240A
—
IN
01
—
1054516
PASSPORT
KY
01
—
163722400
US DEPT OF LABOR
—
01
—
2433673000
PASSPORT ADVANTAGE
KY
01
—
36123
CIGNA
KY
05
—
65917270
—
KY
01
—
CM8616
MEDICARE RAILROAD
KY
Enumeration date
07/10/2006
Last updated
05/23/2008
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