Provider Demographics
NPI:1164682233
Name:RAPIDS FOOT CARE CENTER LLC
Entity Type:Organization
Organization Name:RAPIDS FOOT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:715-423-8637
Mailing Address - Street 1:311 8TH ST SO
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4622
Mailing Address - Country:US
Mailing Address - Phone:715-423-8637
Mailing Address - Fax:715-424-2724
Practice Address - Street 1:311 8TH ST SO
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4622
Practice Address - Country:US
Practice Address - Phone:715-423-8637
Practice Address - Fax:715-424-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI678-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41737500Medicaid
WI43268800Medicaid
WI000082708Medicare PIN
WI000080295Medicare PIN
WIU44068Medicare UPIN
WI4962240001Medicare NSC
WI6229000001Medicare NSC