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General NPI Number Information
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NPI Number | 1982731303
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Entity Type | Organization
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Legal Business Name | MEDICAL FOOT CARE, LLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1315 N FAULKNER DR
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City | CLAREMORE
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State | OK
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Zip | 74017-4601
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Country | US
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Telephone | 918-381-7555
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Fax | 918-341-7301
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Provider Business Mailing Address
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Address Line | 1315 N FAULKNER DR
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City | CLAREMORE
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State | OK
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Zip | 74017-4601
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Country | US
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Telephone | 918-381-7555
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Fax | 918-341-7301
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT B STALCUP
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Credential | PMP
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Telephone | 918-381-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number | 34010
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License Number State | OK
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