Provider Demographics
NPI:1538679196
Name:FAMILY FOOT CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-657-1900
Mailing Address - Street 1:1880 WILLAMETTE FALLS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4653
Mailing Address - Country:US
Mailing Address - Phone:503-657-1900
Mailing Address - Fax:
Practice Address - Street 1:1880 WILLAMETTE FALLS DR STE 111
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4653
Practice Address - Country:US
Practice Address - Phone:503-657-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty