Healthcare Provider Details

I. General information

NPI: 1194850933
Provider Name (Legal Business Name): COMPLETE FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 BROADWATER SQ
BILLINGS MT
59101-1634
US

IV. Provider business mailing address

951 BROADWATER SQ
BILLINGS MT
59101-1634
US

V. Phone/Fax

Practice location:
  • Phone: 406-252-8469
  • Fax: 406-252-8489
Mailing address:
  • Phone: 406-252-8469
  • Fax: 406-252-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number135
License Number StateMT

VIII. Authorized Official

Name: BENJAMIN HOCKIN
Title or Position: OWNER
Credential: DPM
Phone: 406-252-8469