Healthcare Provider Details

I. General information

NPI: 1285778308
Provider Name (Legal Business Name): HEEL TO TOE FOOT CARE PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PRICE AVE
HOMINY OK
74035-2524
US

IV. Provider business mailing address

115 S PRICE AVE
HOMINY OK
74035-2524
US

V. Phone/Fax

Practice location:
  • Phone: 918-885-1264
  • Fax: 918-885-1265
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1532
License Number StateOK

VIII. Authorized Official

Name: ANTHONY WHITEHORN
Title or Position: CEO
Credential:
Phone: 918-885-1264