Provider Demographics
NPI:1356450613
Name:ADVANCED ORTHOPAEDICS OF LOUISVILLE PLLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDICS OF LOUISVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:WITTEN,JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-897-2440
Mailing Address - Street 1:4001 KRESGE WAY STE 330
Mailing Address - Street 2:BAPTIST EAST OFFICE PARK
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-897-2440
Mailing Address - Fax:502-897-2455
Practice Address - Street 1:4001 KRESGE WAY STE 330
Practice Address - Street 2:BAPTIST EAST OFFICE PARK
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-897-2440
Practice Address - Fax:502-897-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20886174400000X
KY25869174400000X
KY19829174400000X
KY24906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00241Medicare PIN