1598743320 NPI number — FALLS CITY LIMB & BRACE CO INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598743320 NPI number — FALLS CITY LIMB & BRACE CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALLS CITY LIMB & BRACE CO INC
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:
LOUISVILLE PROSTHETICS
Provider Other Organization Name Type Code:
3
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:
1598743320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
742 EAST BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-584-2959
Provider Business Mailing Address Fax Number:
502-582-6305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
742 EAST BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-584-2959
Provider Business Practice Location Address Fax Number:
502-582-6305
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUCKETT
Authorized Official First Name:
R
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
CERTIFIED PROSTHETIST/ MANAGER
Authorized Official Telephone Number:
502-584-2959

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100298 . This is a "COMMONWEALTH ADMIN LLC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100298 . This is a "CHA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8200186 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000066275 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57255 . This is a "ABP ADMINISTRATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: D0137620001 . This is a "UNITED AMERICAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000066275 . This is a "ALTERNATIVE HEALTH ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: V603P3355 . This is a "VETERANS ADMINISTRATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000066275 . This is a "ANTHEM SENIOR ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 048291 . This is a "SIHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90130568 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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