Provider Demographics
NPI:1831648161
Name:FAMILY FOOT CARE CENTER LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-673-3505
Mailing Address - Street 1:1627 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2875
Mailing Address - Country:US
Mailing Address - Phone:330-673-3505
Mailing Address - Fax:330-673-4888
Practice Address - Street 1:1627 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2875
Practice Address - Country:US
Practice Address - Phone:330-673-3505
Practice Address - Fax:330-673-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003579213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty