Provider Demographics
NPI:1619985504
Name:COMMONWEALTH PODIATRY PLLC
Entity Type:Organization
Organization Name:COMMONWEALTH PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HASTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-236-5140
Mailing Address - Street 1:3080 HARRODSBURG RD
Mailing Address - Street 2:STE 225
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2774
Mailing Address - Country:US
Mailing Address - Phone:859-296-4272
Mailing Address - Fax:859-296-9645
Practice Address - Street 1:3080 HARRODSBURG RD
Practice Address - Street 2:STE 225
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2774
Practice Address - Country:US
Practice Address - Phone:859-296-4272
Practice Address - Fax:859-296-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
KY00228332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80900244Medicaid
KY90009945Medicaid
KY5135140001Medicare NSC
KY5853Medicare PIN