Provider Demographics
NPI:1225307309
Name:LOUISVILLE PODIATRY PSC
Entity Type:Organization
Organization Name:LOUISVILLE PODIATRY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-458-8989
Mailing Address - Street 1:2525 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2665
Mailing Address - Country:US
Mailing Address - Phone:502-458-8989
Mailing Address - Fax:502-451-5439
Practice Address - Street 1:309 11TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-1435
Practice Address - Country:US
Practice Address - Phone:502-458-8989
Practice Address - Fax:502-451-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00176213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201047510AMedicaid
KY000000753169OtherANTHEM
KY50036964OtherPASSPORT HEALTH PLAN
KY7100242120Medicaid
KYDT2470OtherRAILROAD MEDICARE
INDS6209OtherRAILROAD MEDICARE
INM100062615Medicare PIN
IN201047510AMedicaid
KYK032101Medicare PIN