Provider Demographics
NPI:1083662704
Name:ST. MATTHEWS FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:ST. MATTHEWS FOOT AND ANKLE CLINIC
Other - Org Name:FEET FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-433-5806
Mailing Address - Street 1:117 S HUBBARDS LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3937
Mailing Address - Country:US
Mailing Address - Phone:270-433-5806
Mailing Address - Fax:270-433-2443
Practice Address - Street 1:117 S HUBBARDS LN
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3937
Practice Address - Country:US
Practice Address - Phone:270-433-5806
Practice Address - Fax:270-433-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY195332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000290617OtherBLUECROSS
KY=========OtherTAX ID
KY=========OtherTAX ID