Provider Demographics
NPI:1245390319
Name:FOOT DOCTORS PSC
Entity Type:Organization
Organization Name:FOOT DOCTORS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-897-1616
Mailing Address - Street 1:142 CHENOWETH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2651
Mailing Address - Country:US
Mailing Address - Phone:502-897-1616
Mailing Address - Fax:502-897-7412
Practice Address - Street 1:142 CHENOWETH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2651
Practice Address - Country:US
Practice Address - Phone:502-897-1616
Practice Address - Fax:502-897-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00181213ES0103X, 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
KY000000233615OtherANTHEM
CK2275OtherRAIL ROAD MEDICARE
KY000000233615OtherANTHEM
CK2275OtherRAIL ROAD MEDICARE
4530240001Medicare NSC