Provider Demographics
NPI:1790431211
Name:SMART FEET LLC
Entity type:Organization
Organization Name:SMART FEET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPED
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-437-0134
Mailing Address - Street 1:77 MACK WALTERS RD STE 301B
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1793
Mailing Address - Country:US
Mailing Address - Phone:502-437-0134
Mailing Address - Fax:
Practice Address - Street 1:77 MACK WALTERS RD STE 301B
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1793
Practice Address - Country:US
Practice Address - Phone:502-437-0134
Practice Address - Fax:502-437-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1103830568OtherANTHEM BLUE CROSS BLUE SHIELD
KY7100871590Medicaid
KY286446OtherHME & SERVICES PROVIDER