Provider Demographics
NPI:1053616870
Name:TAWAS FOOT CLINIC
Entity type:Organization
Organization Name:TAWAS FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKI
Authorized Official - Middle Name:
Authorized Official - Last Name:EMRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-6558
Mailing Address - Street 1:166 W M 55
Mailing Address - Street 2:P O BOX 178
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9251
Mailing Address - Country:US
Mailing Address - Phone:989-362-6558
Mailing Address - Fax:989-362-7168
Practice Address - Street 1:166 W M 55
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9251
Practice Address - Country:US
Practice Address - Phone:989-362-6558
Practice Address - Fax:989-362-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001133332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1193620001Medicare NSC