Provider Demographics
NPI:1013931658
Name:FOOT ONE INC
Entity type:Organization
Organization Name:FOOT ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-557-7216
Mailing Address - Street 1:1601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-2025
Mailing Address - Country:US
Mailing Address - Phone:765-557-7216
Mailing Address - Fax:765-557-7223
Practice Address - Street 1:1601 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2025
Practice Address - Country:US
Practice Address - Phone:765-557-7216
Practice Address - Fax:765-557-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000001514OtherMPLAN (HMO)
IN000000111834OtherBCBS OF IN
IN000000111834OtherBCBS OF IN
IN000000001514OtherMPLAN (HMO)