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General NPI Number Information
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NPI Number | 1437207727
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Entity Type | Organization
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Legal Business Name | EXTENDED FOOT CARE SERVICES, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 3610 WATERMELON RD SUITE 103
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City | NORTHPORT
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State | AL
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Zip | 35473-5170
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Country | US
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Telephone | 205-345-9218
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Fax | 205-345-2952
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Provider Business Mailing Address
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Address Line | 3610 WATERMELON RD SUITE 103
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City | NORTHPORT
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State | AL
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Zip | 35473-5170
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Country | US
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Telephone | 205-345-9218
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Fax | 205-345-2952
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK S MARQUIS
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Credential | D.P.M.
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Telephone | 205-345-9218
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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 | 123
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License Number State | AL
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