Provider Demographics
NPI:1942334404
Name:FIRST STEP FOOT CARE, SC
Entity Type:Organization
Organization Name:FIRST STEP FOOT CARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-487-2827
Mailing Address - Street 1:385 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2424
Mailing Address - Country:US
Mailing Address - Phone:847-487-2827
Mailing Address - Fax:847-487-2860
Practice Address - Street 1:385 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2424
Practice Address - Country:US
Practice Address - Phone:847-487-2827
Practice Address - Fax:847-487-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008030213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004254Medicaid
IL950390Medicare PIN
IL632600Medicare PIN
IL016004254Medicaid