Provider Demographics
NPI:1336380518
Name:FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Entity Type:Organization
Organization Name:FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Other - Org Name:FOOT HEALERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-550-3805
Mailing Address - Street 1:PO BOX 28223
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-0223
Mailing Address - Country:US
Mailing Address - Phone:314-550-3805
Mailing Address - Fax:
Practice Address - Street 1:11449 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7108
Practice Address - Country:US
Practice Address - Phone:314-989-1700
Practice Address - Fax:314-989-1710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-17
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4474600001Medicare NSC