Provider Demographics
NPI:1356530323
Name:STEVEN K. SHOEMAKER, DPM AND ASSOCIATES, INC.
Entity type:Organization
Organization Name:STEVEN K. SHOEMAKER, DPM AND ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-781-3223
Mailing Address - Street 1:1421 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6045
Mailing Address - Country:US
Mailing Address - Phone:916-781-3223
Mailing Address - Fax:916-781-8174
Practice Address - Street 1:1421 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6045
Practice Address - Country:US
Practice Address - Phone:916-781-3223
Practice Address - Fax:916-781-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18662ZOtherBLUE SHIELD
CAZZZ18662ZOtherBLUE CROSS
CADE4469OtherRAIL ROAD MEDICARE GROUP #
CADE4469OtherRAIL ROAD MEDICARE GROUP #
CAU31250Medicare UPIN
CAZZZ18662ZOtherBLUE SHIELD