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NPI Code Detail

MEDICARE: FOOTWORKS INC.

MEDICARE: FOOTWORKS INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1707960OTHERKSBLUE CROSS BLUE SHIELD KS
223916010OTHERMOBLUE CROSS BLUE SHIELD MO

General Provider Information

NPI Number : 1073716304
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOTWORKS INC.
Provider Business Mailing Address
First Line : 1152 W 103RD ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-4511
Country : US
Telephone Number : 816-942-3668
Fax Number : 816-942-9402
Provider Business Practice Location Address
First Line : 1152 W 103RD ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-4511
Country : US
Telephone Number : 816-942-3668
Fax Number : 816-942-9402
Authorized Official
Title or Position : PRESIDENT
Name : MR. JEFF R DUBINSKY
Credential : CERTIFIED PEDORTHIST
Telephone Number : 816-942-3668
Provider Enumeration Date : 06/06/2007
Last Update Date : 06/21/2010

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