Basic Information
| Provider Information | |||||||||
| NPI: | 1730369968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED FOOTCARE SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 247 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473200247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652844220 | ||||||||
| FaxNumber: | 7652845254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 N 16TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473624320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652844220 | ||||||||
| FaxNumber: | 7652845254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2007 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7652844220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 07000587 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100135110A | 05 | IN | MEDICAID |