Provider Demographics
NPI:1053326892
Name:FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Entity Type:Organization
Organization Name:FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Other - Org Name:FOOT HEALERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-550-3805
Mailing Address - Street 1:PO BOX 28223
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-0223
Mailing Address - Country:US
Mailing Address - Phone:314-550-3805
Mailing Address - Fax:
Practice Address - Street 1:1726 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4976
Practice Address - Country:US
Practice Address - Phone:636-777-4500
Practice Address - Fax:636-777-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4474600004Medicare NSC