Provider Demographics
NPI:1740480359
Name:FOOTOMAKI TUCSON
Entity type:Organization
Organization Name:FOOTOMAKI TUCSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:520-795-8650
Mailing Address - Street 1:4444 E GRANT RD
Mailing Address - Street 2:# 115
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-795-8650
Mailing Address - Fax:520-795-8687
Practice Address - Street 1:4444 E GRANT RD
Practice Address - Street 2:# 115
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-795-8650
Practice Address - Fax:520-795-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5893930001Medicare NSC