Healthcare Provider Details

I. General information

NPI: 1740926484
Provider Name (Legal Business Name): DIABETIC FOOT CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 WEBSTER RD
SUMMERSVILLE WV
26651-1041
US

IV. Provider business mailing address

3029 WEBSTER RD
SUMMERSVILLE WV
26651-1041
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-9001
  • Fax: 304-872-3218
Mailing address:
  • Phone: 304-872-9001
  • Fax: 304-872-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK J MCKOWN
Title or Position: CEO/OWNER
Credential: COF
Phone: 304-872-9001