NPIMap

Organization Active NPI

Eastern Shore Family Foot Care, LLC

  • Durable Medical Equipment & Medical Supplies
  • Chestertown, MD
National Provider Identifier
1679286132
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
EASTERN SHORE FAMILY FOOT CARE, LLC
Practice address
6412 Church Hill Rd
Chestertown, MD 21620-2386
Phone
(410) 778-1801
Fax
(410) 758-3249
NPI assigned
Dec 29, 2022
Organization subpart
Yes
Parent organization
EASTERN SHORE FAMILY FOOT CARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Authorized official

Name
Mrs. Kimberli Clarkson
Title
Office Manager
Phone
(410) 778-1801

Specialties & licenses 1

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

Addresses

Primary practice location

6412 Church Hill Rd
Chestertown, MD 21620-2386

Mailing address

6412 Church Hill Rd
Chestertown, MD 21620-2386
Phone (410) 778-1801

Other identifiers 1

IdentifierTypeStateIssuer
870023100MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Eastern Shore Family Ft LLC4 organizations share this tax ID, including this one
Part of
Eastern Shore Family Ft LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1672272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1679286132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6412 CHURCH HILL RD",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216202386",
            "telephone_number": "410-778-1801",
            "fax_number": "410-758-3249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6412 CHURCH HILL RD",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216202386",
            "telephone_number": "410-778-1801",
            "fax_number": "410-758-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE FAMILY FOOT CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN SHORE FAMILY FOOT CARE, LLC",
        "enumeration_date": "2022-12-29",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "CLARKSON",
        "authorized_official_first_name": "KIMBERLI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "410-778-1801",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "870023100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chestertown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.