MEDICARE: ASSOCIATES FAMILY FOOT CARE

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36003113R	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619412681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES FAMILY FOOT CARE

Provider Business Mailing Address
First Line	:	PO BOX 128
Second Line	:
City	:	GIRARD
State	:	OH
Zip	:	44420-0128
Country	:	US
Telephone Number	:	330-759-8690
Fax Number	:	330-759-3988

Provider Business Practice Location Address
First Line	:	51 STATE ST
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1939
Country	:	US
Telephone Number	:	330-759-8690
Fax Number	:	330-759-3988

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. CARMELITA R REYES
Credential	:	D.P.M
Telephone Number	:	330-759-8690

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	12/30/2016

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Directions to “ASSOCIATES FAMILY FOOT CARE ” Practice Location

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