Provider Demographics
NPI:1598743320
Name:FALLS CITY LIMB & BRACE CO INC
Entity Type:Organization
Organization Name:FALLS CITY LIMB & BRACE CO INC
Other - Org Name:LOUISVILLE PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:502-584-2959
Mailing Address - Street 1:742 EAST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-584-2959
Mailing Address - Fax:502-582-6305
Practice Address - Street 1:742 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-584-2959
Practice Address - Fax:502-582-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
100298OtherCOMMONWEALTH ADMIN LLC
100298OtherCHA HEALTH
8200186OtherUNITED HEALTH CARE
000000066275OtherANTHEM BCBS
57255OtherABP ADMINISTRATION
D0137620001OtherUNITED AMERICAN
000000066275OtherALTERNATIVE HEALTH ANTHEM
V603P3355OtherVETERANS ADMINISTRATION
000000066275OtherANTHEM SENIOR ADVANTAGE
048291OtherSIHO
KY90130568Medicaid
048291OtherSIHO
57255OtherABP ADMINISTRATION
8200186OtherUNITED HEALTH CARE
=========OtherTRICARE
100298OtherCOMMONWEALTH ADMIN LLC
=========OtherNORTHWOOD NATIONAL
KY0137620001Medicare NSC