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General NPI Number Information
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NPI Number | 1063630291
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Entity Type | Organization
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Legal Business Name | AMBULATORY FOOT CENTER PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 1619 NW HAWTHORNE AVE STE 110
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City | GRANTS PASS
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State | OR
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Zip | 97526-6008
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Country | US
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Telephone | 541-471-7056
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Fax |
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Provider Business Mailing Address
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Address Line | 1619 NW HAWTHORNE AVE STE 110
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City | GRANTS PASS
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State | OR
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Zip | 97526-6008
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Country | US
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Telephone | 541-471-7056
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Fax |
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Authorized Official
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Title or Position | EXCUTIVE OFFICER
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Name | MARK L SIMCHUK
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Credential | DPM
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Telephone | 541-471-7056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00291
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License Number State | OR
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