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1063786077 NPI number — ANKLE & FOOT CARE CLINIC, PC

NPI Number: 1063786077
Health Care Provider/Practitioner: ANKLE & FOOT CARE CLINIC, PC

Information about “1063786077” NPI (ANKLE & FOOT CARE CLINIC, PC) exists in 1063786077 in HTML format HTML  |  1063786077 in plain Text format TXT  |  1063786077 in PDF (Portable Document Format) PDF  |  1063786077 in an XML format XML  formats.

NPI Number : 1063786077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063786077",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANKLE & FOOT CARE CLINIC, PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2831 FORT MISSOULA RD STE 302",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MISSOULA",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59804-7401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-721-1171",
    "MailingAddressFaxNumber": "406-721-0622",
    "FirstLinePracticeLocationAddress": "2831 FORT MISSOULA RD STE 302",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59804-7401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-721-1171",
    "PracticeLocationAddressFaxNumber": "406-721-0622",
    "EnumerationDate": "03/08/2012",
    "LastUpdateDate": "05/06/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHERICK",
    "AuthorizedOfficialFirstName": "FLYNN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPM",
    "AuthorizedOfficialTelephoneNumber": "406-721-1171",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": "88",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332BC3200X",
          "TaxonomyName": "Customized Equipment (DME)",
          "LicenseNumber": "88",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "335E00000X",
          "TaxonomyName": "Prosthetic/Orthotic Supplier",
          "LicenseNumber": "88",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "88",
          "LicenseNumberStateCode": "MT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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