Healthcare Provider Details

I. General information

NPI: 1518587708
Provider Name (Legal Business Name): CAVE RUN ORTHOPEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 FLEMINGSBURG RD
MOREHEAD KY
40351-1810
US

IV. Provider business mailing address

1350 FLEMINGSBURG RD
MOREHEAD KY
40351-1810
US

V. Phone/Fax

Practice location:
  • Phone: 606-462-8016
  • Fax: 606-462-8046
Mailing address:
  • Phone: 606-462-8016
  • Fax: 606-462-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic 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: CHARLES EDWIN CROUSE
Title or Position: OWNER
Credential: MD
Phone: 606-784-7551