Provider Demographics
NPI:1326264607
Name:HERITAGE FOOT CLINIC LLC
Entity Type:Organization
Organization Name:HERITAGE FOOT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-761-5878
Mailing Address - Street 1:208 N VAN BUREN
Mailing Address - Street 2:
Mailing Address - City:WEINER
Mailing Address - State:AR
Mailing Address - Zip Code:72479-8948
Mailing Address - Country:US
Mailing Address - Phone:870-761-5878
Mailing Address - Fax:
Practice Address - Street 1:208 N VAN BUREN
Practice Address - Street 2:
Practice Address - City:WEINER
Practice Address - State:AR
Practice Address - Zip Code:72479-8948
Practice Address - Country:US
Practice Address - Phone:870-761-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty