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General NPI Number Information
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NPI Number | 1033235783
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE MEDICAL CENTER OF NAMPA, P.A.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 203 12TH AVE RD SUITE A
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City | NAMPA
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State | ID
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Zip | 83686-5012
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Country | US
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Telephone | 208-466-3338
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Fax | 208-466-3554
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Provider Business Mailing Address
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Address Line | 203 12TH AVE RD SUITE A
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City | NAMPA
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State | ID
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Zip | 83686-5012
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Country | US
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Telephone | 208-466-3338
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Fax | 208-466-3554
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP NEIL BURK
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Credential | D.P.M.
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Telephone | 208-466-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P-99
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P-99
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License Number State | ID
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