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General NPI Number Information
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NPI Number | 1083711204
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Entity Type | Organization
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Legal Business Name | FULLER REHABILITATION AND CONSULTING SERVICES INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 90 ALEXANDRIA PIKE SUITE 10
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City | FORT THOMAS
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State | KY
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Zip | 41075-4102
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Country | US
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Telephone | 859-442-5191
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Fax | 859-442-5473
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Provider Business Mailing Address
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Address Line | PO BOX 615
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City | RINGGOLD
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State | GA
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Zip | 30736-0615
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Country | US
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Telephone | 706-965-6131
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Fax | 706-413-1352
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MR. CARTER D. FULLER
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Credential |
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Telephone | 706-965-0352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | KY
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Legacy Identifiers
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Identifier #1
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Identifier Code | 2552910
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Identifier #2
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Identifier Code | 200482310A
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Identifier Type | MEDICAID
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Identifier State | IN
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Identifier Issuer |
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Identifier #3
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Identifier Code | 0952950009
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Identifier Type | OTHER
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Identifier State | KY
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Identifier Issuer | MEDICARE ID-TYPE UNSPECIFIED
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Identifier #4
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Identifier Code | 90001918
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Identifier Type | MEDICAID
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Identifier State | KY
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0952950009
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Identifier Type | OTHER
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Identifier State | KY
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Identifier Issuer | MEDICARE ID-TYPE UNSPECIFIED
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Identifier #2
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Identifier Code | 200482310A
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Identifier Type | MEDICAID
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Identifier State | IN
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Identifier Issuer |
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Identifier #3
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Identifier Code | 2552910
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Identifier #4
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Identifier Code | 90001918
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Identifier Type | MEDICAID
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Identifier State | KY
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Identifier Issuer |
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