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Organization
FAMILY FOOT CLINIC
Active
Organization
FAMILY FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FANNIE RENEA BENNETT (MANAGER)
(434) 447-3395
Entity
Organization
Contact information
Practice address
702 PLANK RD, SOUTH HILL, VA 23970-2414
(434) 447-3395
Mailing address
PO BOX 357, 702 PLANK RD, SOUTH HILL, VA 23970-0357
(434) 447-3395
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000943
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010066573
—
VA
01
—
0103000943
LICENSE #
VA
01
—
096430001
CIGNA GOVERMENT SERVICES
—
01
—
105423
ANTHEM BCBS
VA
01
—
26977
OPTIMA / SENTARA
VA
01
—
480018496
RAILROAD MEDICARE
VA
05
—
890801V
—
NC
01
—
U51862
UPIN
VA
Enumeration date
01/28/2009
Last updated
01/28/2009
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