Provider Demographics
NPI:1851987457
Name:BK PODIATRY CENTERS, LLC
Entity Type:Organization
Organization Name:BK PODIATRY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-837-8477
Mailing Address - Street 1:111 FLORISSANT OAKS SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3933
Mailing Address - Country:US
Mailing Address - Phone:314-837-8477
Mailing Address - Fax:314-837-0611
Practice Address - Street 1:7509 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER GRVS
Practice Address - State:MO
Practice Address - Zip Code:63119-2103
Practice Address - Country:US
Practice Address - Phone:314-961-3113
Practice Address - Fax:314-968-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies