Healthcare Provider Details

I. General information

NPI: 1346356284
Provider Name (Legal Business Name): ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13151 MAGISTERIAL DR SUITE 200
LOUISVILLE KY
40223-4103
US

IV. Provider business mailing address

PO BOX 32486
LOUISVILLE KY
40232-2486
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number079020
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number079020
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number079020
License Number StateKY

VIII. Authorized Official

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