Healthcare Provider Details

I. General information

NPI: 1477547073
Provider Name (Legal Business Name): DANVILLE ORTHOPAEDICS & SPORTS MEDICINE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S 3RD ST SUITE B
DANVILLE KY
40422
US

IV. Provider business mailing address

333 S 3RD ST SUITE B
DANVILLE KY
40422-2016
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-8730
  • Fax: 859-236-4468
Mailing address:
  • Phone: 859-236-8730
  • Fax: 859-236-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELLINA M CLAUNCH
Title or Position: CREDENTIALING & BILLING
Credential:
Phone: 859-209-4398