Provider Demographics
NPI:1073695599
Name:NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
Entity Type:Organization
Organization Name:NORTHERN KENTUCKY FOOT SPECIALISTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-746-7461
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-0389
Mailing Address - Country:US
Mailing Address - Phone:859-746-7461
Mailing Address - Fax:859-746-7464
Practice Address - Street 1:1125 BOONE AIRE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1201
Practice Address - Country:US
Practice Address - Phone:859-371-4020
Practice Address - Fax:859-746-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC11409OtherRR MEDICARE
KY80903644Medicaid
KY90040080Medicaid
KY90040080Medicaid