Healthcare Provider Details

I. General information

NPI: 1922137322
Provider Name (Legal Business Name): ARCH CITY FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/31/2024
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025
US

IV. Provider business mailing address

1 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025-1106
US

V. Phone/Fax

Practice location:
  • Phone: 800-707-0215
  • Fax: 800-707-0215
Mailing address:
  • Phone: 800-707-0215
  • Fax: 800-707-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2001014083
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO

VIII. Authorized Official

Name: DENNIS TIMKO
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 636-486-0033