Organization
PEDORTHIC SERVICES, LLC
Active
Other names
Healthy Foot Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY WHEELER C.PED (OWNER)
(859) 266-0420
Entity
Organization
Contact information
Practice address
371 SOUTHLAND DR, LEXINGTON, KY 40503-1824
(859) 266-0420
(859) 266-0667
Mailing address
371 SOUTHLAND DR, LEXINGTON, KY 40503-1824
(859) 266-0420
(859) 266-0667
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000519294
ANTHEM BC/BS
KY
01
—
5574649
AETNA
KY
01
—
5939230001
MEDICARE DME
KY
05
—
7100026770
—
KY
01
—
74928
UNITED HEALTHCARE
KY
Enumeration date
08/16/2006
Last updated
07/27/2020
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