Healthcare Provider Details

I. General information

NPI: 1659444917
Provider Name (Legal Business Name): SALINA FOOT CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 E IRON AVE
SALINA KS
67401-3235
US

IV. Provider business mailing address

1529 E IRON AVE
SALINA KS
67401-3235
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-2900
  • Fax: 785-825-2839
Mailing address:
  • Phone: 785-825-2900
  • Fax: 785-825-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1200240
License Number StateKS

VIII. Authorized Official

Name: TRACIE L BREDFELDT
Title or Position: INSURANCE CLERK
Credential:
Phone: 785-825-2900