Provider Demographics
NPI:1447365721
Name:ALABAMA FAMILY FOOT CLINIC PC
Entity type:Organization
Organization Name:ALABAMA FAMILY FOOT CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-413-0093
Mailing Address - Street 1:PO BOX 7031
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906
Mailing Address - Country:US
Mailing Address - Phone:256-413-0093
Mailing Address - Fax:256-413-0096
Practice Address - Street 1:107 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906
Practice Address - Country:US
Practice Address - Phone:256-413-0093
Practice Address - Fax:256-413-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51054952OtherBCBS
AL3911000001Medicare NSC
U61035Medicare UPIN