Provider Demographics
NPI:1215020896
Name:SOUTHWEST MISSOURI FOOT CLINICS, INC.
Entity Type:Organization
Organization Name:SOUTHWEST MISSOURI FOOT CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:417-782-7500
Mailing Address - Street 1:PO BOX 3592
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3592
Mailing Address - Country:US
Mailing Address - Phone:417-782-7500
Mailing Address - Fax:417-782-7524
Practice Address - Street 1:2630 CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1542
Practice Address - Country:US
Practice Address - Phone:417-782-7500
Practice Address - Fax:417-782-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009605261QP1100X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015173OtherMO MEDICARE GROUP
KS114206OtherKS MEDICARE GROUP
MODG0016OtherRAILROAD MEDICARE
MO504920901Medicaid
MO212522OtherBCBS MO
KS114206OtherKS MEDICARE GROUP
OK=========001OtherBCBS OK
MODG0016OtherRAILROAD MEDICARE
=========OtherTRICARE WEST