Healthcare Provider Details

I. General information

NPI: 1548545395
Provider Name (Legal Business Name): FOOT SPECIALISTS OF GREATER CINCINNATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JAMES SIMPSON JR WAY SUITE 302
COVINGTON KY
41011-0801
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 205
CRESTVIEW HILLS KY
41017-3912
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-9900
  • Fax: 859-341-1649
Mailing address:
  • Phone: 859-341-9900
  • Fax: 859-341-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0164
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number0164
License Number StateKY

VIII. Authorized Official

Name: CHARLES M TIRONE
Title or Position: PRESIDENT
Credential: DPM
Phone: 859-341-9900