=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750567954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEET FIRST INC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2008
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 MIAMISBURG CENTERVILLE RD SUITE 201
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-3758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-847-5551
-----------------------------------------------------
Fax | 937-847-8635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 MIAMISBURG CENTERVILLE RD SUITE 201
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-3758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-847-5551
-----------------------------------------------------
Fax | 937-847-8635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DANIEL J KEANE
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 937-847-5551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 36002572
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------