Provider Demographics
NPI:1508065608
Name:DERBY CITY FOOT DOCTORS PLLC
Entity Type:Organization
Organization Name:DERBY CITY FOOT DOCTORS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EICHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-899-9771
Mailing Address - Street 1:9900 SHELBYVILLE RD STE 11A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2965
Mailing Address - Country:US
Mailing Address - Phone:502-899-9771
Mailing Address - Fax:502-899-9772
Practice Address - Street 1:9900 SHELBYVILLE RD STE 11A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2965
Practice Address - Country:US
Practice Address - Phone:502-899-9771
Practice Address - Fax:502-899-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00296213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80000581Medicaid
KYU99776Medicare UPIN
KY5958090001Medicare NSC
KY00452Medicare PIN