Missouri Foot Care Centers, Inc

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

000552 Issued in MO

Legal business name

MISSOURI FOOT CARE CENTERS, INC

Practice address

1705 Christy Dr.
Suite 209
Jefferson City, MO 65101-5195

Phone

(573) 634-3338

Fax

(573) 634-3985

NPI assigned

Mar 7, 2007

Last updated

Nov 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelli Jeane Ruddle

Title

Office Manager

Phone

(636) 532-3131

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Missouri Foot Care Centers, Inc.

  • Foot & Ankle Surgery Podiatrist
  • Jefferson City, MO
  • NPI 1508035569

  O20081203000198

  Same enrollment

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1316077209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR",
            "address_2": "SUITE 209",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-634-3338",
            "fax_number": "573-634-3985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CHRISTY DR.",
            "address_2": "SUITE 209",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015195",
            "telephone_number": "573-634-3338",
            "fax_number": "573-634-3985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI FOOT CARE CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "RUDDLE",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "JEANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "636-532-3131",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "000552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504901505",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30257410",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364901504",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Missouri CVS Pharmacy LLC (CVS Pharmacy #16228)
• Missouri CVS Pharmacy, L.L.C. (CVS Pharmacy #18087)
• Missouri Dental Specialists
• Missouri Department of Mental Health
• Missouri Doula Association
• Missouri Foot Care Centers, Inc.
• Missouri Medical Imaging, Inc. (Capital Region Medical Imaging)
• Missouri Pharmacist Care Network, LLC (MoPCN)
• Missouri Schools for the Severely Disabled
• Missouri Spine Institute, LLC

• Foot & Ankle Surgery Podiatrist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Foot & Ankle Surgery Podiatrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.