Provider Demographics
NPI:1922384387
Name:FAMILY FOOT & ANKLE CENTER INC PA
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE CENTER INC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-728-4800
Mailing Address - Street 1:8474 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4939
Mailing Address - Country:US
Mailing Address - Phone:513-728-4800
Mailing Address - Fax:513-728-4601
Practice Address - Street 1:7711 EWING BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7533
Practice Address - Country:US
Practice Address - Phone:513-728-4800
Practice Address - Fax:513-728-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00304213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK017791Medicare PIN
KY6515310005Medicare NSC