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General NPI Number Information
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NPI Number | 1174559579
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Entity Type | Organization
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Legal Business Name | SEDALIA FOOT CLINIC PC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 519 E 13TH ST
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City | SEDALIA
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State | MO
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Zip | 65301-5909
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Country | US
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Telephone | 660-826-5897
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Fax | 660-826-4691
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Provider Business Mailing Address
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Address Line | 519 E 13TH ST
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City | SEDALIA
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State | MO
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Zip | 65301-5909
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Country | US
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Telephone | 660-826-5897
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Fax | 660-826-4691
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PAULA A BROWN
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Credential |
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Telephone | 660-826-5897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 000587
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License Number State | MO
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