Provider Demographics
NPI:1629070891
Name:YOUR FOOT FRIEND, INC.
Entity Type:Organization
Organization Name:YOUR FOOT FRIEND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:336-689-0116
Mailing Address - Street 1:233 JOHNS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1650
Mailing Address - Country:US
Mailing Address - Phone:336-889-5909
Mailing Address - Fax:910-390-9002
Practice Address - Street 1:233 JOHNS ROAD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1650
Practice Address - Country:US
Practice Address - Phone:336-889-5909
Practice Address - Fax:910-390-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701886Medicaid
NC5599330001Medicare NSC