MEDICARE: BK PODIATRY CENTERS, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1851987457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BK PODIATRY CENTERS, LLC

Provider Business Mailing Address
First Line	:	111 FLORISSANT OAKS SHOP CTR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-3933
Country	:	US
Telephone Number	:	314-837-8477
Fax Number	:	314-837-0611

Provider Business Practice Location Address
First Line	:	7509 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GRVS
State	:	MO
Zip	:	63119-2103
Country	:	US
Telephone Number	:	314-961-3113
Fax Number	:	314-968-7529

Authorized Official
Title or Position	:	MANAGER
Name	:	MELINDA G JUDGE
Credential	:
Telephone Number	:	314-837-8477

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	01/04/2021

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