MEDICARE: DURRETT'S ORTHOTIC AND PROSTHETIC LLC

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
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8281414	OTHER	KY	AETNA HMO
2	000000032033	OTHER	KY	ANTHEM
3	2433505000	OTHER	KY	PASSPORT ADVANTAGE
4	K002945	OTHER	KY	CHAMPUS
5	66634	OTHER	KY	ABP-EDGEWOOD
6	80444	OTHER	KY	NORTHWOOD
7	PO108	OTHER	KY	CHOICE CARE/HUMANA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	427085	OTHER	KY	CCN-ONE SOURCE
10	45000312	OTHER	KY	EPSDT
11	100139	OTHER	KY	KY HEALTH SELECT
12	1052964	OTHER	KY	PASSPORT
13	P0374	OTHER	KY	HOMELINK
14	21755	OTHER	KY	ABP-SOUTHGATE
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861479016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURRETT'S ORTHOTIC AND PROSTHETIC LLC

Provider Business Mailing Address
First Line	:	20 MEDICAL VILLAGE DR
Second Line	:	SUITE 100
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-341-7688
Fax Number	:	859-341-4476

Provider Business Practice Location Address
First Line	:	20 MEDICAL VILLAGE DR
Second Line	:	SUITE 100
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-341-7688
Fax Number	:	859-341-4476

Authorized Official
Title or Position	:	OWNER
Name	:	SUZIE WARD
Credential	:
Telephone Number	:	859-341-7688

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	12/19/2023

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Directions to “DURRETT'S ORTHOTIC AND PROSTHETIC LLC ” Practice Location

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