Healthcare Provider Details

I. General information

NPI: 1578995155
Provider Name (Legal Business Name): MOTC - LOUISVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 12/15/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10285 CHAMPION FARMS DR
LOUISVILLE KY
40241-6150
US

IV. Provider business mailing address

P O BOX 650846
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-1172
  • Fax: 502-425-1174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST IV
Credential:
Phone: 714-961-2102