Family Foot Care Specialists Podiatry Center Inc
Organization Active NPI Foot & Ankle Surgery Podiatrist · Fortuna, CA
NPI 1699791160 · NPPES record last updated Aug 29, 2014
Key facts
- NPI
- 1699791160
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- FAMILY FOOT CARE SPECIALISTS PODIATRY CENTER INC
- Practice address
- 1730 Main St
Fortuna, CA 95540-2467 - Phone
- (707) 725-5223
- Fax
- (707) 725-2756
- NPI assigned
- Jul 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Neil Robert Kelley, D.P.M.
- Title
- Owner/Ceo
- Phone
- (707) 725-5223
National Provider Directory
Locations
2504 Harrison Ave
Ste B
Eureka, CA 95501
Phone (707) 441-2113
1730 Main St
Ste B
Fortuna, CA 95540
Phone (707) 725-5223
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | CA | Yes | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | E2321 | CA |
Addresses
Primary practice location
1730 Main St
Fortuna, CA 95540-2467
Mailing address
1730 Main St
Fortuna, CA 95540-2467
Phone (707) 725-5223
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GRE001770 | Medicaid | CA | |
| ZZZ64279Z | Other | CA | BLUE SHIELD GROUP TAX ID |
| ZZZ64278Z | Other | CA | BLUE SHIELD GROUP # |
Other providers in Fortuna, CA
- Courtney Embry
- Gabriel Enriquez
- Dana Louise Estevo
- Katherine Anne Talbert Estlin
- Family Foot Care Specialist Podiatry Center
- Neal E Feuerman
- Ana Fernanda Fierro
- Amber Ford
- Fortuna Assisted Living LLC
- Fortuna Chiropractic LLC
All providers in Fortuna, CA · Foot & Ankle Surgery Podiatrist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.