Provider Demographics
NPI:1235446253
Name:FOOT CLINICS LTD
Entity Type:Organization
Organization Name:FOOT CLINICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-877-3668
Mailing Address - Street 1:760 E PUSCH VIEW LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9235
Mailing Address - Country:US
Mailing Address - Phone:520-877-3668
Mailing Address - Fax:520-797-0125
Practice Address - Street 1:760 E PUSCH VIEW LN
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-9235
Practice Address - Country:US
Practice Address - Phone:520-877-3668
Practice Address - Fax:520-797-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ566653Medicaid
AZ566653Medicaid
AZZ141809Medicare PIN