Provider Demographics
NPI:1467512947
Name:H. FRED PREUSS, JR.
Entity Type:Organization
Organization Name:H. FRED PREUSS, JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:PREUSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-923-9837
Mailing Address - Street 1:3684 HIGHWAY 150
Mailing Address - Street 2:STE. 3
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3684 HIGHWAY 150
Practice Address - Street 2:STE. 3
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9692
Practice Address - Country:US
Practice Address - Phone:812-923-9837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00188213E00000X, 213EP1101X, 213ER0200X, 213ES0103X
IN07000617A213E00000X, 213EP1101X, 213ER0200X, 213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80900277Medicaid
IN200521650AMedicaid
IN200521650AMedicaid
IN227850Medicare PIN
KY9654Medicare PIN
INDE5886Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY80900277Medicaid