Provider Demographics
NPI:1316064488
Name:JOEL D FOSTER DPM PC
Entity type:Organization
Organization Name:JOEL D FOSTER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-246-4222
Mailing Address - Street 1:6 N.W. SYCAMORE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4703
Mailing Address - Country:US
Mailing Address - Phone:816-246-4222
Mailing Address - Fax:816-246-4223
Practice Address - Street 1:6 N.W. SYCAMORE ST
Practice Address - Street 2:STE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4703
Practice Address - Country:US
Practice Address - Phone:816-246-4222
Practice Address - Fax:816-246-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000161864213E00000X
MO12-00320305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114125OtherMEDICARE ID TYPE 1
MO305899304Medicaid
P00209482OtherMEDICARE RAILROAD
KS114201OtherMEDICARE ID TYPE 2
KSK90A990OtherMEDICARE ID TYPE UNSPECIFIED
DD1207OtherMEDICARE RAILROAD
KSK90A990OtherMEDICARE ID TYPE UNSPECIFIED
P00209482OtherMEDICARE RAILROAD
KSU84402Medicare UPIN
MOW86F069Medicare PIN