MEDICARE: NORTHERN KENTUCKY FAMILY FOOT CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	239	KY
2	213E00000X	Podiatrist	239	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235132861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN KENTUCKY FAMILY FOOT CARE INC

Provider Business Mailing Address
First Line	:	6200 PLEASANT AVE
Second Line	:	STE 3
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-4671
Country	:	US
Telephone Number	:	513-829-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	7579 ALEXANDRIA PIKE
Second Line	:
City	:	ALEXANDRIA
State	:	KY
Zip	:	41001-1041
Country	:	US
Telephone Number	:	859-635-6666
Fax Number	:	859-635-6607

Authorized Official
Title or Position	:	DPM OWNER
Name	:	ROGER PORTER
Credential	:	DPM
Telephone Number	:	859-635-6666

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/22/2016

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