Provider Demographics
NPI:1366698680
Name:GRANT COUNTY FOOT SPECIALIST
Entity type:Organization
Organization Name:GRANT COUNTY FOOT SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-824-1444
Mailing Address - Street 1:106 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9406
Mailing Address - Country:US
Mailing Address - Phone:859-824-1444
Mailing Address - Fax:
Practice Address - Street 1:106 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9406
Practice Address - Country:US
Practice Address - Phone:859-824-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4423700001Medicare NSC