Provider Demographics
NPI:1689313702
Name:ORTHOPAEDIC CONSULTANTS OF KENTUCKY PLLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC CONSULTANTS OF KENTUCKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:859-553-6474
Mailing Address - Street 1:78 SUMMERTREE DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9714
Mailing Address - Country:US
Mailing Address - Phone:502-523-6695
Mailing Address - Fax:
Practice Address - Street 1:78 SUMMERTREE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9714
Practice Address - Country:US
Practice Address - Phone:859-553-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100827900Medicaid