Provider Demographics
NPI:1104832872
Name:FAMILY FOOT HEALTHCARE LLC
Entity Type:Organization
Organization Name:FAMILY FOOT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GASPAROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-632-5228
Mailing Address - Street 1:609 EAST PLATTE CLAY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429
Mailing Address - Country:US
Mailing Address - Phone:816-632-5228
Mailing Address - Fax:816-632-5229
Practice Address - Street 1:609 EAST PLATTE CLAY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429
Practice Address - Country:US
Practice Address - Phone:816-632-5228
Practice Address - Fax:816-632-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO795213E00000X
KS12000295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO366006500Medicaid
MOL990000Medicare PIN
MO4466470001Medicare NSC
U70957Medicare UPIN