Provider Demographics
NPI:1326233263
Name:FAMILY FOOT CARE, PA
Entity type:Organization
Organization Name:FAMILY FOOT CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:479-484-6717
Mailing Address - Street 1:9000 ROGERS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5249
Mailing Address - Country:US
Mailing Address - Phone:479-484-6717
Mailing Address - Fax:479-484-9648
Practice Address - Street 1:9000 ROGERS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5249
Practice Address - Country:US
Practice Address - Phone:479-484-6717
Practice Address - Fax:479-484-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598707754OtherPROVIDER NPI
AR1326233263OtherGROUP NPI
AR139382717Medicaid
AR5S854G734OtherGROUP MEMBER PTAN
AR5G734OtherGROUP PTAN
AR5S854G734OtherGROUP MEMBER PTAN
1598707754OtherPROVIDER NPI
AR1326233263OtherGROUP NPI