Provider Demographics
NPI:1548545395
Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Entity type:Organization
Organization Name:FOOT SPECIALISTS OF GREATER CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-341-9900
Mailing Address - Street 1:2865 CHANCELLOR DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3912
Mailing Address - Country:US
Mailing Address - Phone:859-341-9900
Mailing Address - Fax:859-341-1649
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-341-9900
Practice Address - Fax:859-341-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0164335E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90003757Medicaid
KY80900004Medicaid
KY4111020003Medicare NSC
KY1467511162Medicare NSC
KY4111020002Medicare NSC
KY90003757Medicaid
KY80900004Medicaid