Provider Demographics
NPI:1518321769
Name:GIAIMO MOBILE PODIATRY LLC
Entity Type:Organization
Organization Name:GIAIMO MOBILE PODIATRY LLC
Other - Org Name:360CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:855-259-9183
Mailing Address - Street 1:12910 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1593
Mailing Address - Country:US
Mailing Address - Phone:855-259-9183
Mailing Address - Fax:
Practice Address - Street 1:300 S AZTEC ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-8811
Practice Address - Country:US
Practice Address - Phone:502-244-2420
Practice Address - Fax:502-996-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00421213E00000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty