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General NPI Number Information
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NPI Number | 1063786077
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Entity Type | Organization
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Legal Business Name | ANKLE & FOOT CARE CLINIC, PC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 2831 FORT MISSOULA RD STE 302
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City | MISSOULA
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State | MT
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Zip | 59804-7401
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Country | US
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Telephone | 406-721-1171
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Fax | 406-721-0622
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Provider Business Mailing Address
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Address Line | 2831 FORT MISSOULA RD STE 302
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City | MISSOULA
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State | MT
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Zip | 59804-7401
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Country | US
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Telephone | 406-721-1171
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Fax | 406-721-0622
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FLYNN SHERICK
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Credential | DPM
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Telephone | 406-721-1171
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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 | 88
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 88
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 88
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 88
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License Number State | MT
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