Provider Demographics
NPI:1477547073
Name:DANVILLE ORTHOPAEDICS & SPORTS MEDICINE, PSC
Entity Type:Organization
Organization Name:DANVILLE ORTHOPAEDICS & SPORTS MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLAUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-209-4398
Mailing Address - Street 1:333 S 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2016
Mailing Address - Country:US
Mailing Address - Phone:859-236-8730
Mailing Address - Fax:859-236-4468
Practice Address - Street 1:333 S 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-8730
Practice Address - Fax:859-236-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100224350Medicaid
KY65911299Medicaid
KY7100224350Medicaid
KY2267Medicare PIN