MEDICARE: AUBURN OPELIKA FAMILY FOOTCARE

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
1	261QP1100X	Podiatric Clinic/Center	132	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480013769	OTHER	AL	MEDICARE R/R PIN
5	CM3112	OTHER	AL	MEDICARE R/R GROUP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	51540360	OTHER	AL	BCBSAL- TUSKEGEE
3	1750484358	OTHER	AL	INDIVIDUAL NPI
4	51540725	OTHER	AL	BCBSAL--OPELIKA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376737528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUBURN OPELIKA FAMILY FOOTCARE

Provider Business Mailing Address
First Line	:	PO BOX 1268
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36831-1268
Country	:	US
Telephone Number	:	334-705-0544
Fax Number	:	334-705-0548

Provider Business Practice Location Address
First Line	:	2121 EXECUTIVE PARK DR
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6041
Country	:	US
Telephone Number	:	334-705-0544
Fax Number	:	334-705-0548

Authorized Official
Title or Position	:	PRESIDENT / PHYSICIAN
Name	:	DR. BRENDA L CASSELBERRY
Credential	:	DPM
Telephone Number	:	334-705-0544

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	07/14/2008

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Directions to “AUBURN OPELIKA FAMILY FOOTCARE ” Practice Location

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