Provider Demographics
NPI:1609067008
Name:RUSTY L. CAIN DPM
Entity Type:Organization
Organization Name:RUSTY L. CAIN DPM
Other - Org Name:DOCTORS FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:LEE
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:2007-08-09
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00349213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6420007001Medicaid
WVSP03881Medicare PIN
WV4610940001Medicare NSC
WVU73984Medicare UPIN