1467433722 NPI number — THE FOOT GROUP P C

Table of content: (NPI 1467433722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467433722 NPI number — THE FOOT GROUP P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FOOT GROUP P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467433722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35813-0487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-772-8566
Provider Business Mailing Address Fax Number:
256-774-8211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 W DUBLIN DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-1787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-772-8566
Provider Business Practice Location Address Fax Number:
256-774-8211
Provider Enumeration Date:
11/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLASINGAME
Authorized Official First Name:
TARA
Authorized Official Middle Name:
L. F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-772-8566

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  AL164 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051514658 . This is a "THE FOOT GROUP'S GROUP #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529918270 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051514659 . This is a "THE FOOT GROUP'S BCBS #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529918240 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q112 . This is a "BCBS GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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