Provider Demographics
NPI:1982731303
Name:MEDICAL FOOT CARE, LLC
Entity Type:Organization
Organization Name:MEDICAL FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:STALCUP
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:918-381-7555
Mailing Address - Street 1:1315 N FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4601
Mailing Address - Country:US
Mailing Address - Phone:918-381-7555
Mailing Address - Fax:918-341-7301
Practice Address - Street 1:1315 N FAULKNER DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4601
Practice Address - Country:US
Practice Address - Phone:918-381-7555
Practice Address - Fax:918-341-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34010261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical