Mountain Crest Foot And Ankle Pa

LBN: Mountain Crest Foot And Ankle Pa
Mountain Crest Foot And Ankle Pa is an health care organization with primary practice located at 3652 Washington Pkwy , Idaho Falls ID 83404-7573. The organization recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as the primary health care specialty. Mountain Crest Foot And Ankle Pa can be contacted via phone (208) 528-8700, or through Black, Timothy Roger via phone (208) 528-8700.

Contact Information

Primary practice address
3652 Washington Pkwy Idaho Falls ID 83404-7573
Phone: (208) 528-8700
Fax: (208) 528-2802
Website:
Map and Directions
Authorized official contact:
Name: Black, Timothy Roger Doctor of Podiatric Medicine (DPM)
Phone: (208) 528-8700

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X P-169 Idaho

Profile Details

NPI number 1932191996
LBN Legal business name Mountain Crest Foot And Ankle Pa
DBA Doing business as
Authorized official Black, Timothy Roger Doctor of Podiatric Medicine (DPM)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 16th, 2005
Last updated Dec 6th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932191996 NPPES
Idaho MEDICAID 806462800

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