Provider Demographics
NPI:1720092182
Name:ASSOCIATES FAMILY FOOT CARE, LLC
Entity Type:Organization
Organization Name:ASSOCIATES FAMILY FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-746-7660
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-0128
Mailing Address - Country:US
Mailing Address - Phone:330-746-7660
Mailing Address - Fax:330-746-8581
Practice Address - Street 1:32 JACOBS RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4908
Practice Address - Country:US
Practice Address - Phone:330-746-7660
Practice Address - Fax:330-759-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003113R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2302547Medicaid
OH2453876Medicaid
OH2302501Medicaid
OH2453876Medicaid
OH5132370002Medicare NSC
OHCK3498Medicare PIN
OH9320082Medicare PIN