MEDICARE: FOOT HEALERS HOLDINGS - ST. LOUIS, 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	:	1982845160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT HEALERS HOLDINGS - ST. LOUIS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 28223
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-0223
Country	:	US
Telephone Number	:	314-550-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 SALT LICK RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-5974
Country	:	US
Telephone Number	:	636-279-1900
Fax Number	:	636-279-1013

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN MURRAY
Credential	:
Telephone Number	:	314-550-3805

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/31/2010

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