Provider Demographics
NPI:1053408674
Name:WEST VIRGINIA FOOT CARE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:WEST VIRGINIA FOOT CARE SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE III
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-757-5880
Mailing Address - Street 1:3860 TEAYS VALLEY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9772
Mailing Address - Country:US
Mailing Address - Phone:304-757-5880
Mailing Address - Fax:304-757-5881
Practice Address - Street 1:3860 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9772
Practice Address - Country:US
Practice Address - Phone:304-757-5880
Practice Address - Fax:304-757-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0204238000Medicaid
WV9306371Medicare PIN
WV0204238000Medicaid