Provider Demographics
NPI:1336214295
Name:THE FOOT SPECIALIST GROUP INC
Entity type:Organization
Organization Name:THE FOOT SPECIALIST GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:W
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-533-4272
Mailing Address - Street 1:PO BOX 681207
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1613
Mailing Address - Country:US
Mailing Address - Phone:256-533-4272
Mailing Address - Fax:256-533-4340
Practice Address - Street 1:401 SIVLEY RD SW STE 3
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5108
Practice Address - Country:US
Practice Address - Phone:256-533-4272
Practice Address - Fax:256-533-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL153213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL480033913OtherRAIL RD
AL529915110Medicaid
AL5074670002Medicare NSC
U55995Medicare UPIN
U55995Medicare UPIN