Provider Demographics
NPI:1508949256
Name:FAMILY FOOT CARE CENTER INC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER INC
Other - Org Name:TIMOTHY N. MALAVOLTI, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MALAVOLTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-294-3668
Mailing Address - Street 1:9318 S TOLEDO CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2746
Mailing Address - Country:US
Mailing Address - Phone:918-294-3668
Mailing Address - Fax:918-747-2759
Practice Address - Street 1:9318 S TOLEDO CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2746
Practice Address - Country:US
Practice Address - Phone:918-294-3668
Practice Address - Fax:918-747-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200127860AMedicaid
OK600522422Medicare PIN
OK200127860AMedicaid