MEDICARE: ST JOSEPH FOOT CLINIC LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1568400216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH FOOT CLINIC LLC

Provider Business Mailing Address
First Line	:	1005A W SAINT MAARTENS DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2989
Country	:	US
Telephone Number	:	816-364-2338
Fax Number	:	816-364-1003

Provider Business Practice Location Address
First Line	:	1005A W SAINT MAARTENS DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2989
Country	:	US
Telephone Number	:	816-364-2338
Fax Number	:	816-364-1003

Authorized Official
Title or Position	:	INSURANCE CLERK
Name	:	MISS JULIE ANN MILLER
Credential	:	PMAC
Telephone Number	:	816-364-2338

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/04/2013

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Directions to “ST JOSEPH FOOT CLINIC LLC ” Practice Location

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