Healthcare Provider Details

I. General information

NPI: 1033235783
Provider Name (Legal Business Name): FOOT & ANKLE MEDICAL CENTER OF NAMPA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 12TH AVE RD SUITE A
NAMPA ID
83686-5012
US

IV. Provider business mailing address

203 12TH AVE RD SUITE A
NAMPA ID
83686-5012
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-3338
  • Fax: 208-466-3554
Mailing address:
  • Phone: 208-466-3338
  • Fax: 208-466-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP-99
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP-99
License Number StateID

VIII. Authorized Official

Name: DR. PHILLIP NEIL BURK
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 208-466-3338