Provider Demographics
NPI:1265603526
Name:AMERICAN FOOT CARE CLINIC PLLC
Entity type:Organization
Organization Name:AMERICAN FOOT CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-648-0444
Mailing Address - Street 1:518 E WHITEHOUSE CANYON RD STE 170
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0544
Mailing Address - Country:US
Mailing Address - Phone:520-648-0444
Mailing Address - Fax:520-648-6920
Practice Address - Street 1:518 E WHITEHOUSE CANYON RD STE 170
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0544
Practice Address - Country:US
Practice Address - Phone:520-648-0444
Practice Address - Fax:520-648-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ189812Medicaid
AZDB8932OtherRAILROAD MEDICARE
AZ0555590002Medicare NSC
AZDPM203BMedicare PIN