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General NPI Number Information
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NPI Number | 1144342338
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Entity Type | Organization
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Legal Business Name | GERIATRIC FOOT CARE OF W VIR
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 2620 FAIRMONT AVE SUITE 203
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City | FAIRMONT
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State | WV
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Zip | 26554-3494
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Country | US
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Telephone | 502-724-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 9016 TAYLORSVILLE RD SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40299-1750
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Country | US
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Telephone | 502-724-0900
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. STEPHEN R. FOLICKMAN
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Credential | D.P.M.
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Telephone | 502-724-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00142
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License Number State | WV
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