Provider Demographics
NPI:1902959984
Name:FAMILY FOOT CARE CLINIC, LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEELA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-523-6050
Mailing Address - Street 1:6724 TROOST AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1500
Mailing Address - Country:US
Mailing Address - Phone:816-523-6050
Mailing Address - Fax:816-523-3741
Practice Address - Street 1:6724 TROOST AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1500
Practice Address - Country:US
Practice Address - Phone:816-523-6050
Practice Address - Fax:816-523-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006039218213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODF8774OtherRAILROAD
38089011OtherBLUE CROSS BLUE SHIELD
38089011OtherBLUE CROSS BLUE SHIELD
MODF8774OtherRAILROAD