Provider Demographics
NPI:1831947399
Name:UNIVERSITY FOOT AND ANKLE CENTER LLC
Entity type:Organization
Organization Name:UNIVERSITY FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-893-1844
Mailing Address - Street 1:3 AUDUBON PLAZA DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-893-1844
Mailing Address - Fax:502-634-3758
Practice Address - Street 1:1802 ALLISON LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5809
Practice Address - Country:US
Practice Address - Phone:502-893-1844
Practice Address - Fax:502-634-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies