Provider Demographics
NPI:1104099746
Name:COMPREHENSIVE FOOT CENTERS
Entity type:Organization
Organization Name:COMPREHENSIVE FOOT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-455-1155
Mailing Address - Street 1:550 RUSH CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9604
Mailing Address - Country:US
Mailing Address - Phone:816-455-1155
Mailing Address - Fax:816-455-1161
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 180
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:816-455-1155
Practice Address - Fax:816-455-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00227213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4152840004Medicare NSC