1518049030 NPI number — NORTHERN KENTUCKY FOOT SPECIALISTS, PSC

Table of content: (NPI 1518049030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518049030 NPI number — NORTHERN KENTUCKY FOOT SPECIALISTS, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518049030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41005-0389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-746-7461
Provider Business Mailing Address Fax Number:
859-746-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4327 WINSTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41015-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-261-8608
Provider Business Practice Location Address Fax Number:
859-261-9292
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIELSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-746-7461

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80903636 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9016059660 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: C11409 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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