Provider Demographics
| NPI: | 1407965015 |
|---|---|
| Name: | LOUISVILLE ORTHOPAEDIC CLINIC & SPORTS REHABILITATION CENTER PSC |
| Entity Type: | Organization |
| Organization Name: | LOUISVILLE ORTHOPAEDIC CLINIC & SPORTS REHABILITATION CENTER PSC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MD |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SCOTT |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | KUIPER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 502-897-1794 |
| Mailing Address - Street 1: | 4130 DUTCHMANS LN |
| Mailing Address - Street 2: | SUITE 300 |
| Mailing Address - City: | LOUISVILLE |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 40207-4710 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 502-897-1794 |
| Mailing Address - Fax: | 502-897-3852 |
| Practice Address - Street 1: | 4130 DUTCHMANS LN STE 300 |
| Practice Address - Street 2: | |
| Practice Address - City: | LOUISVILLE |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 40207-4710 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 502-897-1794 |
| Practice Address - Fax: | 502-897-3852 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-29 |
| Last Update Date: | 2024-02-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
| No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
| No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 7100145820 | Medicaid | |
| KY | 7100915370 | Medicaid | |
| IN | 201294280A | Medicaid | |
| IN | 300073416 | Medicaid | |
| KY | 65933426 | Medicaid | |
| KY | 90135567 | Medicaid | |
| IN | 300012071 | Medicaid | |
| KY | 7100766690 | Medicaid | |
| IN | 100384780A | Medicaid | |
| KY | 7100109060 | Medicaid | |
| KY | 7100109080 | Medicaid |
