MEDICARE: CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, 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	335E00000X	Prosthetic/Orthotic Supplier

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	:	1891829123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF KY, LLC

Provider Business Mailing Address
First Line	:	982 EASTERN PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40217-1566
Country	:	US
Telephone Number	:	502-637-7717
Fax Number	:	502-637-9299

Provider Business Practice Location Address
First Line	:	210 NORTH ST
Second Line	:	SUITE 204
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-4037
Country	:	US
Telephone Number	:	304-325-9969
Fax Number	:	502-637-9299

Authorized Official
Title or Position	:	COO
Name	:	MR. KEITH R SENN
Credential	:
Telephone Number	:	502-899-6350

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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