Provider Demographics
NPI:1104025600
Name:FAMILY FOOTCARE, LLC
Entity Type:Organization
Organization Name:FAMILY FOOTCARE, LLC
Other - Org Name:FAMILY FOOTCARE OF SELMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMEKO
Authorized Official - Middle Name:LYDRITRIUS
Authorized Official - Last Name:MCPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-872-5636
Mailing Address - Street 1:6 OFFICE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6506
Mailing Address - Country:US
Mailing Address - Phone:334-872-5636
Mailing Address - Fax:334-872-5199
Practice Address - Street 1:6 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6506
Practice Address - Country:US
Practice Address - Phone:334-872-5636
Practice Address - Fax:334-872-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL248213E00000X
AL256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU84882Medicare UPIN
AL5227530001Medicare NSC
ALU92576Medicare UPIN