Provider Demographics
NPI:1497980619
Name:RUSTY L. CAIN INC
Entity Type:Organization
Organization Name:RUSTY L. CAIN INC
Other - Org Name:DOCTORS FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-363-3338
Mailing Address - Street 1:1228 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2369
Mailing Address - Country:US
Mailing Address - Phone:304-363-3338
Mailing Address - Fax:304-363-3359
Practice Address - Street 1:1228 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2369
Practice Address - Country:US
Practice Address - Phone:304-363-3338
Practice Address - Fax:304-363-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00349213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016602Medicaid
WV6528300001Medicare NSC
WV9382281Medicare PIN
WVU73984Medicare UPIN