Provider Demographics
NPI:1881963239
Name:FOOT CARE ACROSS AMERICA, LLC
Entity type:Organization
Organization Name:FOOT CARE ACROSS AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:855-851-7202
Mailing Address - Street 1:2207 CONCORD PIKE # 592
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2908
Mailing Address - Country:US
Mailing Address - Phone:855-851-7202
Mailing Address - Fax:
Practice Address - Street 1:14654 RHINESTONE TERRACE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4923
Practice Address - Country:US
Practice Address - Phone:855-851-7201
Practice Address - Fax:855-851-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-212213E00000X
HIPO-194213E00000X
NM338213EP1101X
NV1105213EP1101X
CAE4958213EP1101X
CO708213EP1101X
IA840213EP1101X
NE328213EP1101X
SD199213EP1101X
ND61213EP1101X
MN822213EP1101X
WI972-25213EP1101X
UT7990856-0501213EP1101X
PASC006123213EP1101X
TX1973213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty