Healthcare Provider Details

I. General information

NPI: 1396559779
Provider Name (Legal Business Name): ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 HIGHWAY 44 E STE 4
SHEPHERDSVILLE KY
40165-6081
US

IV. Provider business mailing address

PO BOX 32486
LOUISVILLE KY
40232-2486
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-1236
  • Fax: 502-587-0318
Mailing address:
  • Phone: 502-587-1236
  • Fax: 502-587-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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