Basic Information
| Provider Information | |||||||||
| NPI: | 1639138951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS FOOT CARE ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 SW 6TH AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852727600 | ||||||||
| FaxNumber: | 7852715457 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 SW 6TH AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852727600 | ||||||||
| FaxNumber: | 7852715457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | GALLIANO | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7852727600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 114116 | 01 | BC | OTHER | DA8001 | 01 | RR MCR | OTHER |