Provider Demographics
NPI:1033483763
Name:WHEELING FOOT CLINIC
Entity Type:Organization
Organization Name:WHEELING FOOT CLINIC
Other - Org Name:WHEELING FOOT CLINIC PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSCYOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-810-4648
Mailing Address - Street 1:1061 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2701
Mailing Address - Country:US
Mailing Address - Phone:304-843-5066
Mailing Address - Fax:304-233-0501
Practice Address - Street 1:1061 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2701
Practice Address - Country:US
Practice Address - Phone:304-233-0500
Practice Address - Fax:304-233-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00156213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022864Medicaid
WV1194880047Medicaid