Provider Demographics
NPI:1760548663
Name:AMERICAN FOOTCARE INC
Entity Type:Organization
Organization Name:AMERICAN FOOTCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:918-650-0623
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-0699
Mailing Address - Country:US
Mailing Address - Phone:918-650-0623
Mailing Address - Fax:918-650-0837
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-4233
Practice Address - Country:US
Practice Address - Phone:918-650-0623
Practice Address - Fax:918-650-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100816010AMedicaid
OK100816010AMedicaid
OK=========-001OtherBCBS OF OKLA
OK4778050001Medicare ID - Type Unspecified