Organization
GERIATRIC FOOT CARE OF W VIR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN R. FOLICKMAN D.P.M. (DIRECTOR)
(502) 724-0900
Entity
Organization
Contact information
Practice address
2620 FAIRMONT AVE, SUITE 203, FAIRMONT, WV 26554-3494
(502) 724-0900
Mailing address
9016 TAYLORSVILLE RD, SUITE 101, LOUISVILLE, KY 40299-1750
(502) 724-0900
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00142
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007469000
—
WV
01
—
C31093
RAILROAD MEDICARE
WV
Enumeration date
04/06/2007
Last updated
11/16/2007
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