MEDICARE: FUNDAMENTAL FOOT CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1417823378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNDAMENTAL FOOT CARE, PLLC

Provider Business Mailing Address
First Line	:	735 MAIN RD N
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1902
Country	:	US
Telephone Number	:	207-991-0141
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 MAIN RD N
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-1902
Country	:	US
Telephone Number	:	207-991-0141
Fax Number	:	207-573-1190

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HEATHER FAITH FOGG
Credential	:	RN, BSN, CFCS
Telephone Number	:	207-991-0141

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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