Organization
SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Active
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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