Provider Demographics
NPI:1831804764
Name:EMBOLD FOOT CARE LLC
Entity type:Organization
Organization Name:EMBOLD FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:785-576-9990
Mailing Address - Street 1:981 3600 AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-6044
Mailing Address - Country:US
Mailing Address - Phone:785-576-9990
Mailing Address - Fax:785-576-9990
Practice Address - Street 1:981 3600 AVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-6044
Practice Address - Country:US
Practice Address - Phone:785-479-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1215247416Medicaid