Organization Name: | FAMILY FOOT CLINIC |
NPI Number: | 1326286493 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FANNIE RENEA BENNETT (MANAGER) |
Mailing Address: | 702 Plank Rd South Hill |
State: | VA US |
Postal Code: | 239702414 |
Phone Number: | 4344473395 |
Fax Number: | |
NPI Enumeration Date: | 01/28/2009 |
NPI Last Update Date: | 01/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 0103000943 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |