Healthcare Provider Details

I. General information

NPI: 1215020896
Provider Name (Legal Business Name): SOUTHWEST MISSOURI FOOT CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CUNNINGHAM AVE
JOPLIN MO
64804-1542
US

IV. Provider business mailing address

PO BOX 3592
JOPLIN MO
64803-3592
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-7500
  • Fax: 417-782-7524
Mailing address:
  • Phone: 417-782-7500
  • Fax: 417-782-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number2006009605
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2006009605
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2006009605
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW B RICHINS
Title or Position: PRESIDENT
Credential: DPM
Phone: 417-782-7500