1235152448 NPI number — FOOT SPECIALISTS OF GREATER CINCINNATI

Table of content: (NPI 1235152448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235152448 NPI number — FOOT SPECIALISTS OF GREATER CINCINNATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT SPECIALISTS OF GREATER CINCINNATI
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:
1235152448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 CHANCELLOR DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
CRESTVIEW HILLS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-341-9900
Provider Business Mailing Address Fax Number:
859-341-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2865 CHANCELLOR DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
CRESTVIEW HILLS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-9900
Provider Business Practice Location Address Fax Number:
859-341-1649
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIRONE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-341-9900

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2440449000 . This is a "PASSPORT ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4111020001 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80900004 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1169438 . This is a "PASSPORT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411020001 . This is a "DMEPOS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6113170095003 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18D2083494 . This is a "CLIA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4111020003 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".




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