Provider Demographics
NPI:1518151034
Name:FALCO ENTERPRISES, LLC
Entity Type:Organization
Organization Name:FALCO ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-329-8711
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0271
Mailing Address - Country:US
Mailing Address - Phone:606-329-8711
Mailing Address - Fax:606-324-6291
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-329-8711
Practice Address - Fax:606-324-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23890246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64238900Medicaid
OH0439869Medicaid
KYC75277Medicare UPIN
KY1404901Medicare PIN