Family Foot and Ankle Center of Southern Illinois LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

FAMILY FOOT AND ANKLE CENTER OF SOUTHERN ILLINOIS LLC

Practice address

807 S Division St
Carterville, IL 62918-1528

Phone

(618) 985-3338

Fax

(618) 985-3339

NPI assigned

Jul 14, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Melinda Beth Moore, DPM

Title

Podiatric Physician

Phone

(618) 985-3338

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1881823623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 508",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629180508",
            "telephone_number": "618-985-3338",
            "fax_number": "618-985-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 S DIVISION ST",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629181528",
            "telephone_number": "618-985-3338",
            "fax_number": "618-985-3339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3022 S Park Ave",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483721",
            "country_code": "US",
            "telephone_number": "618-942-3334",
            "fax_number": "618-942-3336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY FOOT AND ANKLE CENTER OF SOUTHERN ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "PODIATRIC PHYSICIAN",
        "authorized_official_telephone_number": "618-985-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoore@familyfootandanklect.sammyehrdirect.com",
            "affiliation": "N",
            "address_1": "807 S Division St",
            "city": "Carterville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629181528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Austin Eichhorn, MS,LCPC
• Amanda Ellis, LCPC
• Helen Ellis, LCSW
• Patty Erwin, ADVANCED
• Olga Falmier, BCBA
• Sarah Faulkner
• Bridget Foy, MA, LPC
• Susan Elain Frease, LCSW
• Trisha Fuller, LCSW
• Morgan A Gant, APN

• Foot & Ankle Surgery Podiatrist in Carterville, IL
• Providers in Carterville, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.