Provider Demographics
NPI:1720346307
Name:FEET FOR LIFE CENTERS INC PC
Entity Type:Organization
Organization Name:FEET FOR LIFE CENTERS INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-983-0303
Mailing Address - Street 1:8637 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1906
Mailing Address - Country:US
Mailing Address - Phone:314-983-0303
Mailing Address - Fax:314-983-2777
Practice Address - Street 1:17280 NORTH OUTER 40 RD STE 203
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1445
Practice Address - Country:US
Practice Address - Phone:314-983-0303
Practice Address - Fax:314-983-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00603213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty