Provider Demographics
NPI:1861479016
Name:DURRETT'S ORTHOTIC AND PROSTHETIC LLC
Entity Type:Organization
Organization Name:DURRETT'S ORTHOTIC AND PROSTHETIC LLC
Other - Org Name:DURRETT'S ORTHOTIC & PROSTHETIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-341-7688
Mailing Address - Street 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-7688
Mailing Address - Fax:859-341-4476
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-341-7688
Practice Address - Fax:859-341-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8281414OtherAETNA HMO
KY000000032033OtherANTHEM
KY2433505000OtherPASSPORT ADVANTAGE
KYK002945OtherCHAMPUS
KY66634OtherABP-EDGEWOOD
KY80444OtherNORTHWOOD
KYPO108OtherCHOICE CARE/HUMANA
OH0662831Medicaid
KY427085OtherCCN-ONE SOURCE
KY45000312OtherEPSDT
KY100139OtherKY HEALTH SELECT
KY1052964OtherPASSPORT
KYP0374OtherHOMELINK
KY21755OtherABP-SOUTHGATE
KY90420597Medicaid
KY=========00OtherCARE WORKS
KYK002945OtherCHAMPUS
KYP0374OtherHOMELINK
KY1052964OtherPASSPORT