Provider Demographics
NPI:1699021477
Name:BULLITT COUNTY FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:BULLITT COUNTY FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-543-1553
Mailing Address - Street 1:421 ADAM SHEPHERD PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6640
Mailing Address - Country:US
Mailing Address - Phone:502-543-1553
Mailing Address - Fax:502-543-1558
Practice Address - Street 1:421 ADAM SHEPHERD PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6640
Practice Address - Country:US
Practice Address - Phone:502-543-1553
Practice Address - Fax:502-543-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00331213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100216360Medicaid
KY7100219890Medicaid
KY7100219890Medicaid
KYK072830Medicare PIN