Provider Demographics
NPI:1467511162
Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-341-9900
Mailing Address - Street 1:2865 CHANCELLOR DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-341-9900
Mailing Address - Fax:859-341-1649
Practice Address - Street 1:2865 CHANCELLOR DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3931
Practice Address - Country:US
Practice Address - Phone:859-341-9900
Practice Address - Fax:859-341-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1169438OtherPASSPORT HEALTH
2440449000OtherPASSPORT ADVANTAGE
KY8090004Medicaid
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