=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144408543
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL FOOTCARE, P. C .
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 06/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5230 HICKORY PARK DR SUITE D
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-934-0661
-----------------------------------------------------
Fax | 804-934-0663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5230 HICKORY PARK DR SUITE D
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-934-0661
-----------------------------------------------------
Fax | 804-934-0663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KRISTIN KAYE GINGRICH
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 804-934-0661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0103300817
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------