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Organization
MISSOURI FOOT CARE CENTERS, INC
Active
Organization
MISSOURI FOOT CARE CENTERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI JEANE RUDDLE (OFFICE MANAGER)
(636) 532-3131
Entity
Organization
Contact information
Practice address
1705 CHRISTY DR., SUITE 209, JEFFERSON CITY, MO 65101-5195
(573) 634-3338
(573) 634-3985
Mailing address
1705 CHRISTY DR, SUITE 209, JEFFERSON CITY, MO 65101-5195
(573) 634-3338
(573) 634-3985
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000552
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30257410
—
MO
05
—
364901504
—
MO
05
—
504901505
—
MO
Enumeration date
03/07/2007
Last updated
11/18/2011
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