MEDICARE: ORTHOPAEDIC CONSULTANTS OF KENTUCKY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689313702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC CONSULTANTS OF KENTUCKY LLC

Provider Business Mailing Address
First Line	:	78 SUMMERTREE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-9714
Country	:	US
Telephone Number	:	502-523-6695
Fax Number	:	859-901-0015

Provider Business Practice Location Address
First Line	:	78 SUMMERTREE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-9714
Country	:	US
Telephone Number	:	859-553-6474
Fax Number	:	859-901-0015

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JASON E DELONG
Credential	:	PA-C
Telephone Number	:	859-553-6474

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	06/24/2025

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Directions to “ORTHOPAEDIC CONSULTANTS OF KENTUCKY LLC ” Practice Location

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