Provider Demographics
NPI:1750610002
Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, LLC
Entity type:Organization
Organization Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-899-9247
Mailing Address - Street 1:902 DUPONT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4602
Mailing Address - Country:US
Mailing Address - Phone:502-899-9247
Mailing Address - Fax:502-899-9443
Practice Address - Street 1:171 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1801
Practice Address - Country:US
Practice Address - Phone:859-264-1817
Practice Address - Fax:859-268-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200124260AMedicaid
KY90351560Medicaid
KY1136130008Medicare NSC