Provider Demographics
NPI:1114147691
Name:BROOKE A. BISBEE, DPM, PA
Entity Type:Organization
Organization Name:BROOKE A. BISBEE, DPM, PA
Other - Org Name:FAMILY FOOT HEALTH CENTER, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BISBEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:479-636-9393
Mailing Address - Street 1:200 S 20TH STREET
Mailing Address - Street 2:STE. B
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1104
Mailing Address - Country:US
Mailing Address - Phone:479-636-9393
Mailing Address - Fax:
Practice Address - Street 1:200 S 20TH ST
Practice Address - Street 2:STE. B
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1104
Practice Address - Country:US
Practice Address - Phone:479-636-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146125748Medicaid
4746160001Medicare NSC
5W274Medicare PIN
AR146125748Medicaid