Healthcare Provider Details

I. General information

NPI: 1699806356
Provider Name (Legal Business Name): FOOT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N GOULD ST
SHERIDAN WY
82801-3928
US

IV. Provider business mailing address

132 N GOULD ST
SHERIDAN WY
82801-3928
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-3457
  • Fax: 307-674-1527
Mailing address:
  • Phone: 307-672-3457
  • Fax: 307-674-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number94
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number94
License Number StateWY

VIII. Authorized Official

Name: CRAIG J MCLAWS
Title or Position: DIRECTOR
Credential: DPM
Phone: 307-672-3457