Healthcare Provider Details

I. General information

NPI: 1295455202
Provider Name (Legal Business Name): ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NORTHGATE CT STE 214
NEW ALBANY IN
47150-6422
US

IV. Provider business mailing address

PO BOX 32486
LOUISVILLE KY
40232-2486
US

V. Phone/Fax

Practice location:
  • Phone: 812-321-6321
  • Fax:
Mailing address:
  • Phone: 502-587-1236
  • Fax: 502-587-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TASHANA M PRESTON
Title or Position: BILLING DIRECTOR
Credential: CPC
Phone: 502-587-1236