Provider Demographics
NPI:1669853776
Name:HOMER FOOT CARE
Entity Type:Organization
Organization Name:HOMER FOOT CARE
Other - Org Name:DR SCOTT M HOMER MFAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-891-9988
Mailing Address - Street 1:7243 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7243 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1301
Practice Address - Country:US
Practice Address - Phone:313-582-6222
Practice Address - Fax:313-582-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002514261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194141010Medicaid
MI0N83370Medicare PIN