Provider Demographics
NPI:1376737528
Name:AUBURN OPELIKA FAMILY FOOTCARE
Entity Type:Organization
Organization Name:AUBURN OPELIKA FAMILY FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASSELBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-705-0544
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-1268
Mailing Address - Country:US
Mailing Address - Phone:334-705-0544
Mailing Address - Fax:334-705-0548
Practice Address - Street 1:2121 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6041
Practice Address - Country:US
Practice Address - Phone:334-705-0544
Practice Address - Fax:334-705-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL132261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL480013769OtherMEDICARE R/R PIN
AL51540360OtherBCBSAL- TUSKEGEE
AL1750484358OtherINDIVIDUAL NPI
AL51540725OtherBCBSAL--OPELIKA
ALCM3112OtherMEDICARE R/R GROUP PIN
AL529912550Medicaid
AL51540725OtherBCBSAL--OPELIKA
AL529912550Medicaid
AL000077574Medicare PIN