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General NPI Number Information
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NPI Number | 1760560015
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Entity Type | Organization
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Legal Business Name | UNIVERSITY FOOT AND ANKLE CENTER LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 3 AUDUBON PLAZA DR STE 320
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City | LOUISVILLE
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State | KY
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Zip | 40217-1319
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Country | US
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Telephone | 502-893-1844
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Fax |
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Provider Business Mailing Address
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Address Line | 3 AUDUBON PLAZA DR STE 320
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City | LOUISVILLE
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State | KY
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Zip | 40217-1319
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Country | US
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Telephone | 502-893-1844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS WAYNE CHILDRESS
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Credential | DPM
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Telephone | 502-893-1844
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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 | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 00209
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License Number State | KY
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