Provider Demographics
NPI:1710064290
Name:FAMILY FOOT HEALTHCARE PLC
Entity Type:Organization
Organization Name:FAMILY FOOT HEALTHCARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-233-6107
Mailing Address - Street 1:927 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2801
Mailing Address - Country:US
Mailing Address - Phone:319-233-6107
Mailing Address - Fax:319-233-9138
Practice Address - Street 1:927 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2801
Practice Address - Country:US
Practice Address - Phone:319-233-6107
Practice Address - Fax:319-233-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00358213ES0103X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710064290Medicaid
IA4866700001Medicare NSC
I8271Medicare PIN
IAI8271Medicare PIN