Provider Demographics
NPI:1750567954
Name:FEET FIRST INC PC
Entity type:Organization
Organization Name:FEET FIRST INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-847-5551
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3758
Mailing Address - Country:US
Mailing Address - Phone:937-847-5551
Mailing Address - Fax:937-847-8635
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3758
Practice Address - Country:US
Practice Address - Phone:937-847-5551
Practice Address - Fax:937-847-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002572213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0757604Medicaid
092070OtherAETNA
000000020376OtherANTHEM
092070OtherAETNA
OH4654450001Medicare NSC