Provider Demographics
NPI:1649590167
Name:FOOT ONE MECHANIX
Entity Type:Organization
Organization Name:FOOT ONE MECHANIX
Other - Org Name:FOOT ONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAIG
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:317-872-3074
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-2025
Mailing Address - Country:US
Mailing Address - Phone:317-872-3074
Mailing Address - Fax:765-557-7223
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2025
Practice Address - Country:US
Practice Address - Phone:317-872-3074
Practice Address - Fax:765-557-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200169600AMedicaid
IN200169600AMedicaid