NPIMap

Organization Active NPI

Southern Orthopedic Associates, S.C.

Doing business as Orthopedic Institute of Western Kentucky

  • Orthopaedic Surgery Physician
  • Paducah, KY
National Provider Identifier
1760790257
Registry record updated Mar 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
042.617215 Issued in IL
Legal business name
SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Doing business as
Orthopedic Institute of Western Kentucky
Practice address
4787 Alben Barkley Dr
Paducah, KY 42001-6789
Phone
(270) 442-9461
Fax
(270) 441-0079
NPI assigned
Sep 17, 2010
Last updated
Mar 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James Michael Davis, M.D.NPI 1063516797
Title
President
Phone
(618) 997-6800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 042617215 IL
Orthopaedic Surgery Physician 207X00000X 042.617215 IL Primary

Addresses

Primary practice location

4787 Alben Barkley Dr
Paducah, KY 42001-6789

Mailing address

510 Lincoln Dr
Herrin, IL 62948-6334
Phone (618) 997-6800

Other identifiers 1

IdentifierTypeStateIssuer
4216620002OtherKYMEDICARE DME

Other names 1

  • Orthopedic Institute of Western Kentucky Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southern Ortho Assoc PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1760790257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629486334",
            "telephone_number": "618-997-6800",
            "fax_number": "618-998-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4787 ALBEN BARKLEY DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420016789",
            "telephone_number": "270-442-9461",
            "fax_number": "270-441-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-997-6800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "042617215",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "042.617215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "4216620002",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopedic Institute of Western Kentucky",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.