Healthcare Provider Details

I. General information

NPI: 1720355670
Provider Name (Legal Business Name): FAMILY FOOTCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 MIDMOST DR SUITE B
MOBILE AL
36609-5510
US

IV. Provider business mailing address

6 OFFICE PARK CIR
SELMA AL
36701-6506
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-3730
  • Fax: 251-344-3731
Mailing address:
  • Phone: 334-872-5636
  • Fax: 334-872-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number256
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number248
License Number StateAL

VIII. Authorized Official

Name: TOMEKO L MCPHILLIPS
Title or Position: OWNER
Credential: DPM
Phone: 334-872-5636