Provider Demographics
NPI:1093097933
Name:COMMONWEALTH FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-459-3338
Mailing Address - Street 1:1915 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1901
Mailing Address - Country:US
Mailing Address - Phone:502-459-3338
Mailing Address - Fax:502-459-7509
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 240
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-459-3338
Practice Address - Fax:502-459-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00157332B00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100246740Medicaid
KY7100246740Medicaid