Organization Name: | SOUTHWEST FAMILY FOOTCARE SPECIALIST, LLC |
NPI Number: | 1326236514 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REGINA LYNNE SPEARS (PRESIDENT) |
Mailing Address: | 10570 Blue Star M Hwy South Haven |
State: | MI US |
Postal Code: | 490908923 |
Phone Number: | 2696391115 |
Fax Number: | 2696392525 |
NPI Enumeration Date: | 10/12/2007 |
NPI Last Update Date: | 12/04/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 5901001629 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |