Organization
SPORTS MEDICINE SURGICAL SPECIALISTS PLLC
Active
Other names
Kentuckiana Foot and Ankle Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH WELLINGTON MYRICK DPM (OWNER/AUTHORIZED OFFICIAL)
(502) 721-8288
Entity
Organization
Contact information
Practice address
210 E GRAY ST # 820, LOUISVILLE, KY 40202-3900
(502) 585-3668
(502) 585-3662
Mailing address
6400 DUTCHMANS PKWY STE 215, LOUISVILLE, KY 40205-3343
(502) 721-8288
(502) 721-8792
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/16/2019
Last updated
06/02/2021
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