Healthcare Provider Details

I. General information

NPI: 1326730052
Provider Name (Legal Business Name): RIVER VALLEY TOTAL FOOT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 END OF ROAD ST
POTEAU OK
74953-5482
US

IV. Provider business mailing address

312 END OF ROAD ST
POTEAU OK
74953-5482
US

V. Phone/Fax

Practice location:
  • Phone: 918-649-5349
  • Fax:
Mailing address:
  • Phone: 918-649-5349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALERIE ORSBURN
Title or Position: OWNER
Credential: RN
Phone: 918-649-5349