Organization
OLDHAM COUNTY FOOT & ANKLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASEN T PEDERSEN DPM (OWNER)
(502) 276-9999
Entity
Organization
Contact information
Practice address
6400 WESTWIND WAY, SUITE B, CRESTWOOD, KY 40014-6773
(502) 276-9999
Mailing address
6400 WESTWIND WAY, SUITE B, CRESTWOOD, KY 40014-6773
(502) 276-9999
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7100571860
MEDICAID DME
KY
05
—
7100580750
—
KY
Enumeration date
03/18/2014
Last updated
09/08/2020
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