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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