Organization
SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Active
Other names
Orthopedic Institute of Western Kentucky
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MICHAEL DAVIS M.D. (PRESIDENT)
(618) 997-6800
Entity
Organization
Contact information
Practice address
4787 ALBEN BARKLEY DRIVE, PADUCAH, KY 42002
(270) 442-9461
(270) 441-0079
Mailing address
510 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-6800
(618) 998-9635
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
042617215
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100080520
—
KY
Enumeration date
08/24/2006
Last updated
12/02/2015
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