1235132861 NPI number — NORTHERN KENTUCKY FAMILY FOOT CARE 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 1235132861 NPI number — NORTHERN KENTUCKY FAMILY FOOT CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN KENTUCKY FAMILY FOOT CARE 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:
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:
1235132861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 PLEASANT AVE
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-4671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-829-9333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7579 ALEXANDRIA PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41001-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-635-6666
Provider Business Practice Location Address Fax Number:
859-635-6607
Provider Enumeration Date:
05/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PORTER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
DPM OWNER
Authorized Official Telephone Number:
859-635-6666

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  239 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 239 , 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: 90003716 . This is a "MEDICAID DME" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100159900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".