Provider Demographics
NPI:1386678365
Name:UNIVERSITY ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPAEDIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:502-584-7525
Mailing Address - Street 1:210 E GRAY ST
Mailing Address - Street 2:#900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3900
Mailing Address - Country:US
Mailing Address - Phone:502-584-7525
Mailing Address - Fax:502-589-0849
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-562-6501
Practice Address - Fax:502-562-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207X00000X, 207XS0117X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049629OtherPASSPORT
KYCJ5284OtherRAILROAD MEDICARE
KY667790OtherCIGNA
KY2432606000OtherPASSPORT ADVANTAGE
KY65931875Medicaid
IN100397490AMedicaid
KY667790OtherCIGNA