Provider Demographics
NPI:1922152933
Name:MARTIN FOX M.D.
Entity Type:Organization
Organization Name:MARTIN FOX M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-895-5850
Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4640
Mailing Address - Country:US
Mailing Address - Phone:502-895-5850
Mailing Address - Fax:502-895-1210
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-895-5850
Practice Address - Fax:502-895-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000059331OtherBLUE CROSS
KY1051837OtherPASSPORT
KY0810095OtherAETNA
KYCI6878OtherRAILROAD MEDICARE
KY65937302Medicaid
KY0810095OtherAETNA
KY1051837OtherPASSPORT
KYCI6878OtherRAILROAD MEDICARE