Provider Demographics
NPI:1174718548
Name:FRANKFORT FOOT CLINIC, PLLC
Entity type:Organization
Organization Name:FRANKFORT FOOT CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRICKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-227-7569
Mailing Address - Street 1:5 PHYSICIANS PARK
Mailing Address - Street 2:STE 3
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4163
Mailing Address - Country:US
Mailing Address - Phone:502-227-7569
Mailing Address - Fax:502-227-4442
Practice Address - Street 1:5 PHYSICIANS PARK
Practice Address - Street 2:STE 3
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4163
Practice Address - Country:US
Practice Address - Phone:502-227-7569
Practice Address - Fax:502-227-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00246213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDA7703OtherRAILROAD MEDICARE
KY4488300001Medicare NSC
KYDA7703OtherRAILROAD MEDICARE