MEDICARE: ROBERT J HERBST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	213E00000X	Podiatrist	00353	KY

General Provider Information

NPI Number	:	1447612163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT J HERBST

Provider Business Mailing Address
First Line	:	600 MEIJER DR STE 104
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-4878
Country	:	US
Telephone Number	:	859-757-8262
Fax Number	:	859-282-0976

Provider Business Practice Location Address
First Line	:	302 6TH AVE
Second Line	:
City	:	DAYTON
State	:	KY
Zip	:	41074-1116
Country	:	US
Telephone Number	:	859-757-8262
Fax Number	:	859-282-0976

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT J HERBST
Credential	:	DPM
Telephone Number	:	859-757-8262

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	06/02/2021

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