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General NPI Number Information
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NPI Number | 1184740359
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Entity Type | Organization
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Legal Business Name | FOOT HEALTH CENTER, PA
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 430 S OHIO ST
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City | SALINA
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State | KS
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Zip | 67401-3177
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Country | US
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Telephone | 785-825-0003
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Fax | 785-825-0099
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Provider Business Mailing Address
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Address Line | 430 S OHIO ST
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City | SALINA
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State | KS
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Zip | 67401-3177
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Country | US
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Telephone | 785-825-0003
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Fax | 785-825-0099
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SHANE FREDERIKSEN
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Credential | DPM
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Telephone | 785-825-0003
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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 | 12-00322
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License Number State | KS
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