Provider Demographics
NPI:1629215058
Name:KENTUCKY FOOT PROFESSIONALS
Entity Type:Organization
Organization Name:KENTUCKY FOOT PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHLUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-278-7313
Mailing Address - Street 1:2130 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2520
Mailing Address - Country:US
Mailing Address - Phone:859-278-7313
Mailing Address - Fax:859-260-1007
Practice Address - Street 1:2130 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2520
Practice Address - Country:US
Practice Address - Phone:859-278-7313
Practice Address - Fax:859-260-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00872Medicare PIN
KY6174160001Medicare NSC