Provider Demographics
NPI:1942790431
Name:KENNEY ORTHOPEDICS OF MONROE, LLC
Entity Type:Organization
Organization Name:KENNEY ORTHOPEDICS OF MONROE, LLC
Other - Org Name:KENNEY ORTHOPEDICS OF MONROE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-305-1136
Mailing Address - Street 1:208 NORMANDY CT
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9169
Mailing Address - Country:US
Mailing Address - Phone:859-241-1015
Mailing Address - Fax:859-241-1088
Practice Address - Street 1:1420 ELLEN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5173
Practice Address - Country:US
Practice Address - Phone:704-635-7029
Practice Address - Fax:704-635-7495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEY ORTHO GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326385949Medicaid