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General NPI Number Information
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NPI Number | 1346356284
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Entity Type | Organization
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Legal Business Name | ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 13151 MAGISTERIAL DR SUITE 200
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City | LOUISVILLE
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State | KY
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Zip | 40223-4103
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Country | US
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Telephone | 502-587-1236
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Fax | 502-587-0126
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Provider Business Mailing Address
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Address Line | PO BOX 32486
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City | LOUISVILLE
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State | KY
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Zip | 40232-2486
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Country | US
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Telephone | 502-587-1236
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Fax | 502-587-0126
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | TASHANA M PRESTON
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Credential | CPC
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Telephone | 502-587-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 079020
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 079020
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 079020
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License Number State | KY
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