NPIMap

Organization Active NPI

DRS. Foot Source, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Watertown, WI
National Provider Identifier
1376624064
Registry record updated Nov 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DRS. FOOT SOURCE, INC.
Practice address
101 Oakridge CT
Suite B
Watertown, WI 53094-4100
Phone
(920) 262-8822
Fax
(920) 262-6337
NPI assigned
Oct 18, 2006
Last updated
Nov 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2009

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

Authorized official

Name
Dr. Victor S. Soderstrom, D.P.M.NPI 1508810110
Title
Owner
Phone
(920) 262-8822

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

101 Oakridge CT
Suite B
Watertown, WI 53094-4100

Mailing address

101 Oakridge CT
Suite B
Watertown, WI 53094-4100
Phone (920) 262-8822

Other identifiers 1

IdentifierTypeStateIssuer
41736500MedicaidWI

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

101 Oakridge Ct
Ste B
Watertown, WI 53094
Phone (920) 262-8822

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259107200000",
    "number": "1376624064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OAKRIDGE CT",
            "address_2": "SUITE B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944100",
            "telephone_number": "920-262-8822",
            "fax_number": "920-262-6337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OAKRIDGE CT",
            "address_2": "SUITE B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530944100",
            "telephone_number": "920-262-8822",
            "fax_number": "920-262-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. FOOT SOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-11-25",
        "status": "A",
        "authorized_official_last_name": "SODERSTROM",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-262-8822",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41736500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2009; 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.