Healthcare Provider Details

I. General information

NPI: 1346268315
Provider Name (Legal Business Name): NEO FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE SW STE 102
MIAMI OK
74354-6708
US

IV. Provider business mailing address

PO BOX 1323
MIAMI OK
74355-1323
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7655
  • Fax: 918-540-7668
Mailing address:
  • Phone: 918-540-7655
  • Fax: 918-540-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number223
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number223
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0058567
License Number StateOK

VIII. Authorized Official

Name: DR. MATTHEW H ROBERTS
Title or Position: OWNER
Credential: D.P.M.
Phone: 918-540-7655