Provider Demographics
NPI:1053395244
Name:STEP AHEAD FOOT CARE SC
Entity type:Organization
Organization Name:STEP AHEAD FOOT CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:309-944-5546
Mailing Address - Street 1:241 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1236
Mailing Address - Country:US
Mailing Address - Phone:309-944-5546
Mailing Address - Fax:309-944-8267
Practice Address - Street 1:241 N STATE ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1236
Practice Address - Country:US
Practice Address - Phone:309-944-5546
Practice Address - Fax:309-944-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5319270001Medicare NSC
210695Medicare ID - Type Unspecified