Healthcare Provider Details

I. General information

NPI: 1619301751
Provider Name (Legal Business Name): COMMUNITY FOOT CLINIC OF MCPHERSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W 4TH ST
MCPHERSON KS
67460-2301
US

IV. Provider business mailing address

316 W 4TH ST
MCPHERSON KS
67460-2301
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-3313
  • Fax: 620-241-6967
Mailing address:
  • Phone: 620-241-3313
  • Fax: 620-241-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number12-00301
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number12-00301
License Number StateKS

VIII. Authorized Official

Name: TRENT J TIMSON
Title or Position: PODIATRIST
Credential: DPM
Phone: 620-241-3313