NPIMap

Organization Active NPI

Family Foot Clinic, SC

  • Podiatrist
  • Fond Du Lac, WI
National Provider Identifier
1063515526
Registry record updated May 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
FAMILY FOOT CLINIC, SC
Practice address
21 S Marr St
Fond Du Lac, WI 54935-4334
Phone
(920) 921-1669
Fax
(920) 921-7950
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ian Charles Furness, DPM
Title
President
Phone
(920) 921-1669

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X WI Primary

Addresses

Primary practice location

21 S Marr St
Fond Du Lac, WI 54935-4334

Mailing address

21 S Marr St
Fond Du Lac, WI 54935-4334
Phone (920) 921-1669

Other identifiers 2

IdentifierTypeStateIssuer
CQ2458OtherWIRR/MEDICARE
43264100MedicaidWI

National Provider Directory

National Provider Directory

Locations

400 Highway K
Fond du Lac, WI 54937
Phone (920) 906-1000

751 Cty Road K
Fond du Lac, WI 54937
Phone (920) 929-3800

200 S Madison St
Waupun, WI 53963
Phone (920) 324-5571

1 W Lincoln St
Waupun, WI 53963
Phone (920) 324-5577

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1063515526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 S MARR ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354334",
            "telephone_number": "920-921-1669",
            "fax_number": "920-921-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 S MARR ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354334",
            "telephone_number": "920-921-1669",
            "fax_number": "920-921-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FOOT CLINIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2010-05-21",
        "status": "A",
        "authorized_official_last_name": "FURNESS",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-921-1669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR/MEDICARE",
            "identifier": "CQ2458",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43264100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.