Provider Demographics
NPI:1881757425
Name:RIVER CITY ORTHOPAEDIC SURGEONS, PSC
Entity type:Organization
Organization Name:RIVER CITY ORTHOPAEDIC SURGEONS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-935-8061
Mailing Address - Street 1:9300 STONESTREET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2876
Mailing Address - Country:US
Mailing Address - Phone:502-935-8061
Mailing Address - Fax:502-933-7010
Practice Address - Street 1:9300 STONESTREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2876
Practice Address - Country:US
Practice Address - Phone:502-935-8061
Practice Address - Fax:502-933-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1083879OtherPASSPORT
KY3435655000OtherPASSPORT ADVANTAGE
KYCL1931OtherRAILROAD MEDICARE
KY65922528Medicaid
KY65922528Medicaid
KY0343740001Medicare NSC