Provider Demographics
NPI:1235202136
Name:TOTAL FOOT CARE LLC
Entity Type:Organization
Organization Name:TOTAL FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-473-1296
Mailing Address - Street 1:1035 BELLEVUE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1845
Mailing Address - Country:US
Mailing Address - Phone:314-473-1296
Mailing Address - Fax:314-442-7766
Practice Address - Street 1:1035 BELLEVUE AVE STE 315
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1856
Practice Address - Country:US
Practice Address - Phone:314-473-1296
Practice Address - Fax:314-442-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024287213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty