Provider Demographics
NPI:1891829123
Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, LLC
Entity Type:Organization
Organization Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-899-6350
Mailing Address - Street 1:982 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1566
Mailing Address - Country:US
Mailing Address - Phone:502-637-7717
Mailing Address - Fax:502-637-9299
Practice Address - Street 1:210 NORTH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4037
Practice Address - Country:US
Practice Address - Phone:304-325-9969
Practice Address - Fax:502-637-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90351560Medicaid
KY1050355Medicaid