Provider Demographics
NPI:1740926484
Name:DIABETIC FOOT CARE CENTER INC
Entity type:Organization
Organization Name:DIABETIC FOOT CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKOWN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:304-872-9001
Mailing Address - Street 1:3029 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1041
Mailing Address - Country:US
Mailing Address - Phone:304-872-9001
Mailing Address - Fax:304-872-3218
Practice Address - Street 1:3029 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1041
Practice Address - Country:US
Practice Address - Phone:304-872-9001
Practice Address - Fax:304-872-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies