Organization
FAMILY FOOT CARE SPECIALISTS PODIATRY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL ROBERT KELLEY D.P.M. (OWNER/CEO)
(707) 725-5223
Entity
Organization
Contact information
Practice address
1730 MAIN ST, FORTUNA, CA 95540-2467
(707) 725-5223
(707) 725-2756
Mailing address
1730 MAIN ST, FORTUNA, CA 95540-2467
(707) 725-5223
(707) 725-2756
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
CA
332B00000X
Durable Medical Equipment & Medical Supplies
E2321
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GRE001770
—
CA
01
—
ZZZ64278Z
BLUE SHIELD GROUP #
CA
01
—
ZZZ64279Z
BLUE SHIELD GROUP TAX ID
CA
Enumeration date
07/15/2006
Last updated
08/29/2014
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