Thad R. Schulten PSC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

THAD R. SCHULTEN PSC

Practice address

4515 Churchman Ave.
Louisville, KY 40215

Phone

(502) 361-0134

Fax

(502) 361-0137

NPI assigned

Jul 25, 2007

Organization subpart

Yes

Parent organization

KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERYAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Penny Boone

Title

Office Manager

Phone

(502) 361-0134

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Kentucky Center for Oral & Maxillofacial Surgery Doing business as
• Kentucky Center for Oral & Maxillofacial Surgery PSC Other name

Part of

Daniel Morrow Nicol C

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1235329400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 CHURCHMAN AVE.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-361-0134",
            "fax_number": "502-361-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 CHURCHMAN AVE.",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-361-0134",
            "fax_number": "502-361-0137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6225 W Highway 146",
            "address_purpose": "LOCATION",
            "city": "Crestwood",
            "state": "KY",
            "postal_code": "400147595",
            "country_code": "US",
            "telephone_number": "502-241-0714",
            "fax_number": "502-361-0137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THAD R. SCHULTEN PSC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENTUCKY CENTER FOR ORAL & MAXILLOFACIAL SURGERY",
        "enumeration_date": "2007-07-25",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "502-361-0134"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65941114",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentucky Center for Oral & Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kentucky Center for Oral & Maxillofacial Surgery PSC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Matthew Tewell
• Mary Lorene Texas, N.P.
• TH Consultancy LLC
• Jennifer Thacker
• Noah Steven Thackeray
• Alexander Thai
• Julie Thake, PTA
• Ashish Thaker, DC
• Andrew Paul Thaliath
• Emily Thaman

• Oral and Maxillofacial Surgery (Dentist) in Louisville, KY
• Providers in Louisville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.