Healthcare Provider Details

I. General information

NPI: 1619005865
Provider Name (Legal Business Name): OK FOOT & ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 S PENNSYLVANIA AVE STE A
OKLAHOMA CITY OK
73159-6913
US

IV. Provider business mailing address

9315 S PENNSYLVANIA AVE STE A OKLAHOMA FOOT & ANKLE SPECIALISTS
OKC OK
73159-6913
US

V. Phone/Fax

Practice location:
  • Phone: 405-691-9004
  • Fax: 405-691-9003
Mailing address:
  • Phone: 405-691-9004
  • Fax: 405-691-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number289
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number233
License Number StateOK

VIII. Authorized Official

Name: KARI L. JOHNSON
Title or Position: BILLING/CREDENTIALING
Credential:
Phone: 405-691-9004