Organization
FOOT HEALTH CENTERS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA M REAGAN (OFFICE ADMINISTRATOR)
(618) 344-4449
Entity
Organization
Contact information
Practice address
122 E ZUPAN ST, MARYVILLE, IL 62062-2010
(618) 344-4449
(618) 344-4551
Mailing address
122 E ZUPAN ST, MARYVILLE, IL 62062-2010
(618) 344-4449
(618) 344-4551
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
060-004872
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060101285
BC/BS GROUP#
IL
01
—
CB0674
RAILROAD MEDICARE GROUP#
IL
Enumeration date
07/08/2006
Last updated
05/23/2024
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