Healthcare Provider Details

I. General information

NPI: 1750579736
Provider Name (Legal Business Name): MCSHANE FOOT AND ANKLE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 S STEWART AVE
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1834 S STEWART AVE
SPRINGFIELD MO
65804-2519
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-3338
  • Fax: 417-889-0953
Mailing address:
  • Phone: 417-889-3338
  • Fax: 417-889-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000632
License Number StateMO

VIII. Authorized Official

Name: DR. PATRICK ANDERSON MCSHANE
Title or Position: OWNER
Credential: DPM
Phone: 417-889-3338