Provider Demographics
NPI:1740214824
Name:FAMILY FOOT HEALTH PC
Entity Type:Organization
Organization Name:FAMILY FOOT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-278-6394
Mailing Address - Street 1:300 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036
Mailing Address - Country:US
Mailing Address - Phone:517-278-6394
Mailing Address - Fax:517-278-4394
Practice Address - Street 1:300 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-278-6394
Practice Address - Fax:517-278-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILW000696213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI48-0A21007-0OtherBLUE CROSS GROUP
MI1349989Medicaid
MI485125110OtherBLUE CROSS BLUE SCHEILD
MI48-0A21007-0OtherBLUE CROSS GROUP