Provider Demographics
NPI:1518587708
Name:CAVE RUN ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:CAVE RUN ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-784-7551
Mailing Address - Street 1:1350 FLEMINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1810
Mailing Address - Country:US
Mailing Address - Phone:606-462-8016
Mailing Address - Fax:606-462-8046
Practice Address - Street 1:1350 FLEMINGSBURG RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1810
Practice Address - Country:US
Practice Address - Phone:606-462-8016
Practice Address - Fax:606-462-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100670440Medicaid
18D2186089OtherCLIA WAIVER
KY7100670190Medicaid
KY7100672660Medicaid