MEDICARE: FOOTPRINT, LLC

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1568967800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTPRINT, LLC

Provider Business Mailing Address
First Line	:	5728 CONSTANCE CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5728 CONSTANCE CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1063
Country	:	US
Telephone Number	:	757-339-7799
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FITZROY SMITH
Credential	:
Telephone Number	:	757-339-7799

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

Similar Medicare Providers

1861858268 — FITZROY SMITH
Practice Location Address:

5728 CONSTANCE CT
VIRGINIA BEACH, VA
23462-1063

Practice Phone: 757-292-0541
Practice Fax:

1740285196 — LEON F. STEWART-HAL S. MARCHMAN CENTER, INC.
Practice Location Address:

3875 TIGER BAY RD
DAYTONA BEACH, FL
32124-1063

Practice Phone: 386-947-1328
Practice Fax: 386-947-1323

1750311411 — LINCARE INC.
Practice Location Address:

1063 ARMORY DR
OSAGE BEACH, MO
65065

Practice Phone: 573-348-9393
Practice Fax: 573-348-9299

1437345634 — WANDA LUONG B.A.
Practice Location Address:

4548 N LAKEWOOD BLVD , 1/4
LONG BEACH, CA
90808-1063

Practice Phone: 323-842-9655
Practice Fax:

1013171537 — STEWART MARCHMAN CENTER INC
Practice Location Address:

3875 TIGER BAY RD
DAYTONA BEACH, FL
32124-1063

Practice Phone: 386-947-1330
Practice Fax:

1598904435 — VICKA HEALTH CARE SERVICES INC.
Practice Location Address:

1063 GOLDEN LAKES BLVD , SUITE 326
ROYAL PALM BEACH, FL
33411-3357

Practice Phone: 561-818-1805
Practice Fax: 561-296-6259

Directions to “FOOTPRINT, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.