Provider Demographics
NPI:1417005133
Name:FISHER & HINNANT PROSTHETICS AND ORTHOTICS, INC.
Entity Type:Organization
Organization Name:FISHER & HINNANT PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINNANT
Authorized Official - Suffix:
Authorized Official - Credentials:CP LPO
Authorized Official - Phone:502-425-1172
Mailing Address - Street 1:10285 CHAMPION FARMS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-425-1172
Mailing Address - Fax:502-425-1174
Practice Address - Street 1:10285 CHAMPION FARMS DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-425-1172
Practice Address - Fax:502-425-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90100470Medicaid
KY90100470Medicaid