Provider Demographics
NPI:1427071844
Name:FOOT HEALTH CENTER OF MID-MISSOURI LLC
Entity type:Organization
Organization Name:FOOT HEALTH CENTER OF MID-MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:573-659-2376
Mailing Address - Street 1:3207 W TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0892
Mailing Address - Country:US
Mailing Address - Phone:573-659-2376
Mailing Address - Fax:573-893-3342
Practice Address - Street 1:3207 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0892
Practice Address - Country:US
Practice Address - Phone:573-659-2376
Practice Address - Fax:573-893-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO000667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25894OtherBC/BS
MODF1787OtherRAILROAD MEDICARE
MO248520OtherHEALTHLINK
MO4565615OtherAETNA
MO4565615OtherAETNA
MO=========OtherMERCY