Provider Demographics
NPI:1013518950
Name:MOBILE FOOT CARE SPECIALISTS, L.L.C.
Entity Type:Organization
Organization Name:MOBILE FOOT CARE SPECIALISTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KESHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MS, EMBA
Authorized Official - Phone:216-409-6783
Mailing Address - Street 1:38752 RENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-5229
Mailing Address - Country:US
Mailing Address - Phone:216-409-6783
Mailing Address - Fax:440-866-6700
Practice Address - Street 1:38752 RENWOOD AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-5229
Practice Address - Country:US
Practice Address - Phone:216-409-6783
Practice Address - Fax:440-866-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty