Provider Demographics
NPI:1467433722
Name:THE FOOT GROUP P C
Entity Type:Organization
Organization Name:THE FOOT GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L F
Authorized Official - Last Name:BLASINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:D P M
Authorized Official - Phone:256-772-8566
Mailing Address - Street 1:PO BOX 6487
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35813-0487
Mailing Address - Country:US
Mailing Address - Phone:256-772-8566
Mailing Address - Fax:256-774-8211
Practice Address - Street 1:131 W DUBLIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1787
Practice Address - Country:US
Practice Address - Phone:256-772-8566
Practice Address - Fax:256-774-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-13
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL164213ES0131X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051514658OtherTHE FOOT GROUP'S GROUP #
AL529918270Medicaid
AL051514659OtherTHE FOOT GROUP'S BCBS #
AL529918240Medicaid
ALQ112OtherBCBS GROUP PAYEE NUMBER
AL051514658Medicare PIN
AL051514658OtherTHE FOOT GROUP'S GROUP #
ALL182Medicare PIN
AL4778500001Medicare NSC
AL529918240Medicaid