Provider Demographics
NPI:1972947315
Name:FOOT TRAFFIC, LLC
Entity Type:Organization
Organization Name:FOOT TRAFFIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC SOLE MEMBER, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLETT
Authorized Official - Middle Name:JULENA
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, LPED
Authorized Official - Phone:405-707-3005
Mailing Address - Street 1:724 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4668
Mailing Address - Country:US
Mailing Address - Phone:405-707-3005
Mailing Address - Fax:405-707-3033
Practice Address - Street 1:724 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4668
Practice Address - Country:US
Practice Address - Phone:405-707-3005
Practice Address - Fax:405-707-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-27
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6754740001Medicare NSC