Provider Demographics
NPI:1700162526
Name:FALLS CITY LIMB & BRACE CO, INC
Entity Type:Organization
Organization Name:FALLS CITY LIMB & BRACE CO, INC
Other - Org Name:LOUISVILLE PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER, CERT. PROSTHETI
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CP, CPED
Authorized Official - Phone:502-584-2959
Mailing Address - Street 1:1404 BROWNS LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4655
Mailing Address - Country:US
Mailing Address - Phone:502-895-8050
Mailing Address - Fax:502-895-8056
Practice Address - Street 1:1404 BROWNS LN
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4655
Practice Address - Country:US
Practice Address - Phone:502-895-8050
Practice Address - Fax:502-895-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90130568Medicaid
000000066275OtherANTHEM BC/BS
IN100000700AMedicaid