Organization
FAMILY FOOT CARE SPECIALIST PODIATRY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL R KELLEY DPM (OWNER)
(707) 725-5223
Entity
Organization
Contact information
Practice address
1730 MAIN ST, FORTUNA, CA 95540-2451
(707) 725-5223
(707) 725-2756
Mailing address
1730 MAIN ST, FORTUNA, CA 95540-2451
(707) 725-5223
(707) 725-2756
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699791160 01
—
CA
Enumeration date
11/09/2006
Last updated
07/17/2014
Update your record
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