Provider Demographics
NPI:1295455202
Name:ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Entity type:Organization
Organization Name:ELLIS & BADENHAUSEN ORTHOPAEDICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:502-587-1236
Mailing Address - Street 1:PO BOX 32486
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40232-2486
Mailing Address - Country:US
Mailing Address - Phone:502-587-1236
Mailing Address - Fax:502-587-0126
Practice Address - Street 1:3605 NORTHGATE CT STE 214
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6422
Practice Address - Country:US
Practice Address - Phone:812-321-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2025-02-27
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
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty