Healthcare Provider Details

I. General information

NPI: 1619985504
Provider Name (Legal Business Name): COMMONWEALTH PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 HARRODSBURG RD STE 225
LEXINGTON KY
40503-2774
US

IV. Provider business mailing address

3080 HARRODSBURG RD STE 225
LEXINGTON KY
40503-2774
US

V. Phone/Fax

Practice location:
  • Phone: 859-296-4272
  • Fax: 859-296-9645
Mailing address:
  • Phone: 859-296-4272
  • Fax: 859-296-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00228
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00228
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET LEE HASTE
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-236-5140