Provider Demographics
NPI:1689967119
Name:JACOB B GOLDSTEIN DPM LLC
Entity Type:Organization
Organization Name:JACOB B GOLDSTEIN DPM LLC
Other - Org Name:FOOT PAIN CENTER OF KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-856-8150
Mailing Address - Street 1:230-C EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1643
Mailing Address - Country:US
Mailing Address - Phone:913-856-8150
Mailing Address - Fax:913-856-8390
Practice Address - Street 1:230-C EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1643
Practice Address - Country:US
Practice Address - Phone:913-856-8150
Practice Address - Fax:913-856-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200358KS213E00000X
KS12-00358KS213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2249Medicare PIN
KS6696780001Medicare NSC