Provider Demographics
NPI:1619017548
Name:SUBURBAN FOOT CARE
Entity Type:Organization
Organization Name:SUBURBAN FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:COMESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-432-5683
Mailing Address - Street 1:11709 OLD BALLAS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7029
Mailing Address - Country:US
Mailing Address - Phone:314-432-5683
Mailing Address - Fax:314-997-7212
Practice Address - Street 1:11709 OLD BALLAS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7029
Practice Address - Country:US
Practice Address - Phone:314-432-5683
Practice Address - Fax:314-997-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000410213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42818Medicare UPIN