Provider Demographics
NPI:1861746059
Name:PERSONAL FOOTCARE LLC
Entity type:Organization
Organization Name:PERSONAL FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:WINFRED
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-732-1211
Mailing Address - Street 1:2020 WAKEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2112
Mailing Address - Country:US
Mailing Address - Phone:804-732-1211
Mailing Address - Fax:804-733-5946
Practice Address - Street 1:424 BRACEY LN
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1631
Practice Address - Country:US
Practice Address - Phone:434-447-6988
Practice Address - Fax:434-447-5850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL FOOTCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000377332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies