Provider Demographics
NPI:1477732386
Name:FAMILY FOOT CLINIC, INC
Entity Type:Organization
Organization Name:FAMILY FOOT CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-449-7323
Mailing Address - Street 1:1800 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4768
Mailing Address - Country:US
Mailing Address - Phone:406-449-7323
Mailing Address - Fax:406-449-0015
Practice Address - Street 1:1800 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4768
Practice Address - Country:US
Practice Address - Phone:406-449-7323
Practice Address - Fax:406-449-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT78213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00445806OtherRAILROAD MEDICARE
MT1477732386Medicaid
MT1477732386Medicaid
6045690001Medicare NSC