Provider Demographics
NPI:1164593232
Name:HEALTHY FEET LLC
Entity Type:Organization
Organization Name:HEALTHY FEET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-241-9565
Mailing Address - Street 1:3512 ROCKVILLE RD
Mailing Address - Street 2:SUITE 118B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3998
Mailing Address - Country:US
Mailing Address - Phone:317-241-9565
Mailing Address - Fax:317-241-0100
Practice Address - Street 1:3512 ROCKVILLE RD
Practice Address - Street 2:SUITE 118B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3998
Practice Address - Country:US
Practice Address - Phone:317-241-9565
Practice Address - Fax:317-241-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200459780AMedicaid