Provider Demographics
NPI:1548484819
Name:FEET FOR LIFE CENTERS INC PC
Entity type:Organization
Organization Name:FEET FOR LIFE CENTERS INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-983-0303
Mailing Address - Street 1:8637 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1906
Mailing Address - Country:US
Mailing Address - Phone:314-983-0303
Mailing Address - Fax:314-983-2777
Practice Address - Street 1:8637 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1906
Practice Address - Country:US
Practice Address - Phone:314-983-0303
Practice Address - Fax:314-983-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024583111NS0005X
MO2012010878213ES0103X
MO000603213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0941610001Medicare NSC
MO480015750Medicare PIN
MO000021208Medicare PIN