MEDICARE: SALINA FOOT CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1200240	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659444917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALINA FOOT CLINIC, P.A.

Provider Business Mailing Address
First Line	:	1529 E IRON AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3235
Country	:	US
Telephone Number	:	785-825-2900
Fax Number	:	785-825-2839

Provider Business Practice Location Address
First Line	:	1529 E IRON AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3235
Country	:	US
Telephone Number	:	785-825-2900
Fax Number	:	785-825-2839

Authorized Official
Title or Position	:	INSURANCE CLERK
Name	:	TRACIE L BREDFELDT
Credential	:
Telephone Number	:	785-825-2900

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	05/16/2008

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