| |
2300 Chamber Center Dr, Suite 100, Lakeside Park, KY 41017-1673 | |
(859) 331-2440 | |
(859) 331-2449 |
Full Name | |
---|---|
Type | Facility |
Speciality | Durable Medical Equipment & Medical Supplies |
Location | 2300 Chamber Center Dr, Lakeside Park, Kentucky |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720314966 | NPI | - | NPPES |
7100096290 | Medicaid | KY | |
80000151 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 00258 (Kentucky) | Secondary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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Po Box 636389, Cincinnati, OH 45263-0001 Ph: (859) 557-4260 | 2300 Chamber Center Dr, Suite 100, Lakeside Park, KY 41017-1673 Ph: (859) 331-2440 |