Provider Demographics
NPI:1831300078
Name:ROSALINE FOOT CARE A PODIATRY GROUP, INC.
Entity Type:Organization
Organization Name:ROSALINE FOOT CARE A PODIATRY GROUP, INC.
Other - Org Name:MERCY FOOT CARE A PODIATRY GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-244-3338
Mailing Address - Street 1:1950 ROSALINE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2543
Mailing Address - Country:US
Mailing Address - Phone:530-244-3338
Mailing Address - Fax:530-244-3342
Practice Address - Street 1:1950 ROSALINE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2543
Practice Address - Country:US
Practice Address - Phone:530-244-3338
Practice Address - Fax:530-244-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ24148Z284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24148ZMedicare ID - Type UnspecifiedFACILITY NUMBER