Provider Demographics
NPI:1205188711
Name:FOOT AND ANKLE CARE, PSC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-409-5580
Mailing Address - Street 1:6407 PRESTON HWY
Mailing Address - Street 2:SUITE#1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1850
Mailing Address - Country:US
Mailing Address - Phone:502-409-5580
Mailing Address - Fax:502-409-5582
Practice Address - Street 1:3906 S DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4647
Practice Address - Country:US
Practice Address - Phone:502-409-5580
Practice Address - Fax:502-409-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6423520002Medicare NSC