Provider Demographics
NPI:1730321845
Name:ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Entity Type:Organization
Organization Name:ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CURL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-587-1236
Mailing Address - Street 1:13151 MAGISTERIAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4103
Mailing Address - Country:US
Mailing Address - Phone:502-587-1236
Mailing Address - Fax:502-587-0126
Practice Address - Street 1:4123 DUTCHMANS LN STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4718
Practice Address - Country:US
Practice Address - Phone:502-587-1236
Practice Address - Fax:502-587-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY079020207X00000X
KY332B00000X
363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - 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
KY0643220001Medicare NSC