=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144264979
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY FEET, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 SIRIUS AVE SUITE #104
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-7821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-270-4388
-----------------------------------------------------
Fax | 702-270-4388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 SIRIUS AVE SUITE #104
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-7821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-270-4388
-----------------------------------------------------
Fax | 702-270-4388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. JEFF BLUTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-548-5579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------