Healthcare Provider Details

I. General information

NPI: 1457431942
Provider Name (Legal Business Name): ST CHARLES FOOT CARE CENTER, TERRY L. GAMACHE, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S KINGSHIGHWAY ST
SAINT CHARLES MO
63301-1636
US

IV. Provider business mailing address

110 S KINGSHIGHWAY ST
SAINT CHARLES MO
63301-1636
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-9399
  • Fax: 636-946-1972
Mailing address:
  • Phone: 636-946-9399
  • Fax: 636-946-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000344
License Number StateMO

VIII. Authorized Official

Name: DR. TERRY L GAMACHE
Title or Position: OWNER
Credential: DPM
Phone: 636-946-9399