Provider Demographics
NPI:1750559829
Name:DR BROOKS FOOT CARE
Entity type:Organization
Organization Name:DR BROOKS FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-325-7079
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0690
Mailing Address - Country:US
Mailing Address - Phone:304-325-7079
Mailing Address - Fax:304-327-0614
Practice Address - Street 1:324 NORTH ST STE 1
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-325-7079
Practice Address - Fax:304-327-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV230213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011431Medicaid
WV9374421Medicare PIN
WVT89968Medicare UPIN
WV6147980001Medicare NSC