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General NPI Number Information
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NPI Number | 1093135634
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Entity Type | Organization
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Legal Business Name | ANKLE & FOOT MEDICAL CENTER PC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 222 N 2ND ST SUITE 301
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City | BOISE
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State | ID
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Zip | 83702-6109
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Country | US
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Telephone | 208-344-3324
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Fax | 208-344-4349
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Provider Business Mailing Address
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Address Line | 222 N 2ND ST SUITE 301
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City | BOISE
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State | ID
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Zip | 83702-6109
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Country | US
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Telephone | 208-344-3324
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Fax | 208-344-4349
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KURT KINGHORN
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Credential | DPM
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Telephone | 208-344-3324
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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 | P-230
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License Number State | ID
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