Provider Demographics
NPI:1033357314
Name:FAMILY FOOT CARE LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-928-4447
Mailing Address - Street 1:1475 KISKER RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8781
Mailing Address - Country:US
Mailing Address - Phone:636-928-4447
Mailing Address - Fax:636-928-4497
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304
Practice Address - Country:US
Practice Address - Phone:636-928-4447
Practice Address - Fax:636-928-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000758213E00000X
MO000806213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437115979OtherINDIVIDUAL NPI
MO1013911395OtherINDIVIDUAL NPI