Provider Demographics
NPI:1053424572
Name:FIVE INDIANA FOOT LLC
Entity type:Organization
Organization Name:FIVE INDIANA FOOT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HUPFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-475-8900
Mailing Address - Street 1:PO BOX 15454
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0454
Mailing Address - Country:US
Mailing Address - Phone:812-475-8900
Mailing Address - Fax:812-475-0024
Practice Address - Street 1:3700 BELLEMEADE AVE STE 117
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0106
Practice Address - Country:US
Practice Address - Phone:812-475-8900
Practice Address - Fax:812-475-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000766A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121220Medicaid
IN100121220Medicaid
IN5783950001Medicare NSC
IN235410Medicare PIN