MEDICARE: COMPREHENSIVE FOOT CENTERS

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		MO

General Provider Information

NPI Number	:	1972785558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE FOOT CENTERS

Provider Business Mailing Address
First Line	:	5601 NE ANTIOCH RD
Second Line	:	SUITE 7
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2302
Country	:	US
Telephone Number	:	816-455-1155
Fax Number	:	816-455-1161

Provider Business Practice Location Address
First Line	:	5601 NE ANTIOCH RD
Second Line	:	SUITE 7
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2302
Country	:	US
Telephone Number	:	816-455-1155
Fax Number	:	816-455-1161

Authorized Official
Title or Position	:	OWNER
Name	:	MR. THOMAS BOLDRY
Credential	:	DPM
Telephone Number	:	816-455-1155

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

Similar Medicare Providers

1841290624 — MR. THOMAS NATHAN SEXTON DPM
Practice Location Address:

5601 NE ANTIOCH RD , STE 7
GLADSTONE, MO
64119-2302

Practice Phone: 816-455-1155
Practice Fax: 816-455-1161

1578503702 — MRS. KENDRA LYNN PEARSON DC
Practice Location Address:

5601 NE ANTIOCH RD , SUITE 8
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64119-2302

Practice Phone: 816-452-4488
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1396817441 — DR. BILLY RONALD ROMMEL DDS
Practice Location Address:

5601 NE ANTIOCH RD , STE 5
GLADSTONE, MO
64119-2302

Practice Phone: 816-455-1200
Practice Fax: 816-455-1021

1639193758 — DR. ROBERT T. SAMUEL O.D.
Practice Location Address:

5601 NE ANTIOCH RD
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64119-2302

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1265380968 — POTENS WELLNESS CLINIC LLC
Practice Location Address:

2800 NE KENDALLWOOD PKWY STE 3
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1417626516 — MATTHEW VANDENDAELE PT, DPT
Practice Location Address:

6403 N PROSPECT AVE STE 450
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64119-1545

Practice Phone: 816-656-3698
Practice Fax: 816-368-9488

Directions to “COMPREHENSIVE FOOT CENTERS ” Practice Location

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