Organization
FOOTPHARMACY DIRECT
Active
Other names
Orthotic World
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL LEE PENNINGTON C.O.S. (SALES MANAGER)
(800) 860-2773
Entity
Organization
Contact information
Practice address
906 W MCDERMOTT DR, STE.116-312, ALLEN, TX 75013-6510
(800) 860-2773
(469) 675-0831
Mailing address
906 W MCDERMOTT DR, STE.116-312, ALLEN, TX 75013-6510
(800) 860-2773
(469) 675-0831
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPED-3-008
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
519675848
UNITED HEALTH CARE
—
01
—
90079283
BCBS
—
Enumeration date
02/04/2008
Last updated
01/29/2015
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