Provider Demographics
NPI:1588640189
Name:ORTHOPEDIC TRAUMA ASSOCIATES, PSC
Entity Type:Organization
Organization Name:ORTHOPEDIC TRAUMA ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-629-5460
Mailing Address - Street 1:234 E GRAY ST
Mailing Address - Street 2:SUITE 564
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-629-5460
Mailing Address - Fax:502-629-5461
Practice Address - Street 1:234 E GRAY ST
Practice Address - Street 2:SUITE 564
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-629-5460
Practice Address - Fax:502-629-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227460Medicaid
KY64225279Medicaid
0274803Medicare ID - Type Unspecified
E79000Medicare UPIN
KY64227460Medicaid
0274801Medicare ID - Type Unspecified
KY02748Medicare PIN