Provider Demographics
NPI:1578863254
Name:ADVANCED BIOMECHANICAL CONCEPTS PLLC
Entity Type:Organization
Organization Name:ADVANCED BIOMECHANICAL CONCEPTS PLLC
Other - Org Name:ABC ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-261-1488
Mailing Address - Street 1:11872 CAPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6332
Mailing Address - Country:US
Mailing Address - Phone:502-261-1488
Mailing Address - Fax:502-261-1470
Practice Address - Street 1:11872 CAPITAL WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6332
Practice Address - Country:US
Practice Address - Phone:502-261-1488
Practice Address - Fax:502-261-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KYCO004117335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90008012Medicaid
KY1689798522OtherANTHEM
KY4986480001Medicare NSC