Provider Demographics
NPI:1467638817
Name:FAMILY FOOT CARE AND SURGERY, LLC
Entity type:Organization
Organization Name:FAMILY FOOT CARE AND SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-353-2396
Mailing Address - Street 1:247 BROAD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 BROAD ST STE 3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3273
Practice Address - Country:US
Practice Address - Phone:203-876-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000509335E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000509J185OtherCIGNA HEALTHCARE
CT030000509CT05OtherBLUE CROSS BLUE SHIELD
CT004099257Medicaid
CT480035180OtherRAILROAD MEDICARE
CT2885050004OtherCIGNA HEALTHCARE
CT030000509CT06OtherBLUE CROSS BLUE SHIELD
CT2V2611OtherHEALTHNET
CTNHS138OtherOXFORD HEALTH
CT2V2611OtherHEALTHNET
CT030000509CT05OtherBLUE CROSS BLUE SHIELD
CT004099257Medicaid