| NPI | 1073252375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE KIBBE Owner 502-834-5676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2026-01-20 |