Provider Demographics
NPI:1720355670
Name:FAMILY FOOTCARE LLC
Entity Type:Organization
Organization Name:FAMILY FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-872-5636
Mailing Address - Street 1:6 OFFICE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6506
Mailing Address - Country:US
Mailing Address - Phone:334-872-5636
Mailing Address - Fax:334-872-5199
Practice Address - Street 1:4358 MIDMOST DR
Practice Address - Street 2:SUITE B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5510
Practice Address - Country:US
Practice Address - Phone:251-344-3730
Practice Address - Fax:251-344-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL248213E00000X
AL256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU84882Medicare UPIN
ALU92576Medicare UPIN
AL5227530002Medicare NSC