Provider Demographics
NPI:1306871835
Name:THE FOOT FARM LLC
Entity type:Organization
Organization Name:THE FOOT FARM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-523-4402
Mailing Address - Street 1:8231 CORINTH MALL
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5305
Mailing Address - Country:US
Mailing Address - Phone:913-341-3668
Mailing Address - Fax:913-341-1315
Practice Address - Street 1:8231 CORINTH MALL
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5305
Practice Address - Country:US
Practice Address - Phone:913-341-3668
Practice Address - Fax:913-341-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5483120002Medicare NSC