MEDICARE: THE FOOT FARM 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1669593539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FOOT FARM LLC

Provider Business Mailing Address
First Line	:	4167 N MULBERRY DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-1638
Country	:	US
Telephone Number	:	816-382-3668
Fax Number	:	816-382-3670

Provider Business Practice Location Address
First Line	:	4167 N MULBERRY DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-1638
Country	:	US
Telephone Number	:	816-382-3668
Fax Number	:	816-382-3670

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN RICHARD
Credential	:
Telephone Number	:	785-523-4402

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	12/20/2008

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Directions to “THE FOOT FARM LLC ” Practice Location

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