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Organization
ADVANCED FOOT & ANKLE CARE LLC
Active
Organization
ADVANCED FOOT & ANKLE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL LYNN MCKINLEY DPM (OWNER)
(270) 769-1303
Entity
Organization
Contact information
Practice address
708 WESTPORT RD, SUITE 102, ELIZABETHTOWN, KY 42701-2866
(270) 769-1303
Mailing address
708 WESTPORT RD, SUITE 102, ELIZABETHTOWN, KY 42701-2866
(270) 769-1303
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00280
KY
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50002812
PASSPORT HEALTH PLAN
KY
05
—
7100320600
—
KY
05
—
80900194
—
KY
01
—
DA7050
RAILROAD MEDICARE
KY
Enumeration date
05/04/2007
Last updated
02/18/2015
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