Provider Demographics
NPI:1659842045
Name:IOWA FOOT CARE CENTER LLC
Entity type:Organization
Organization Name:IOWA FOOT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-233-0943
Mailing Address - Street 1:217 DUFF AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6609
Mailing Address - Country:US
Mailing Address - Phone:515-233-0943
Mailing Address - Fax:515-663-8052
Practice Address - Street 1:217 DUFF AVE STE 2
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6609
Practice Address - Country:US
Practice Address - Phone:515-233-0943
Practice Address - Fax:515-663-8052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBERLY J HARMON DBA IOWA FOOT CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-10
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPOD50015OtherREGISTRATION OF RADIATION EMITTING MACHINES
IA00664OtherMEDICAL LICENSE
IA1710151OtherCERTIFICATE OF REGISTRATION-IOWA CONTROLLED SUBSTANCES ACT
FH7999141OtherFEDERAL CONTROLLED SUBSTANCES REGISTRATION #
IAPOD50015OtherREGISTRATION OF RADIATION EMITTING MACHINES
IABE5374575OtherIOWA CONTROLLED SUBSTANCES REGISTRATION #
5012960001OtherDME PTAN