Organization
NORTHERN KENTUCKY FAMILY FOOT CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER PORTER DPM (DPM OWNER)
(859) 635-6666
Entity
Organization
Contact information
Practice address
7579 ALEXANDRIA PIKE, ALEXANDRIA, KY 41001-1041
(859) 635-6666
(859) 635-6607
Mailing address
6200 PLEASANT AVE, STE 3, FAIRFIELD, OH 45014-4671
(513) 829-9333
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
239
KY
332B00000X
Durable Medical Equipment & Medical Supplies
239
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100159900
—
KY
01
—
90003716
MEDICAID DME
KY
Enumeration date
05/27/2005
Last updated
03/22/2016
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