| NPI | 1972783157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL W HALL Owner/Dpm 859-623-3550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: KY 00274) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00274) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2019-09-19 |