Provider Demographics
NPI:1750418232
Name:FOOT CARE CLINIC LLC
Entity type:Organization
Organization Name:FOOT CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:SATO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-896-8847
Mailing Address - Street 1:71-1411 PUU KAMANU LN
Mailing Address - Street 2:#82
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8334
Mailing Address - Country:US
Mailing Address - Phone:808-896-8847
Mailing Address - Fax:808-325-1035
Practice Address - Street 1:71-1411 PUU KAMANU LN
Practice Address - Street 2:#82
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8334
Practice Address - Country:US
Practice Address - Phone:808-896-8847
Practice Address - Fax:808-325-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 163WE0900X
HI788363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000262147OtherHMSA
HIH102218Medicare PIN
HI102218Medicare PIN