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General NPI Number Information
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NPI Number | 1306020060
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Entity Type | Organization
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Legal Business Name | NEW MARTINSVILLE FOOT AND ANKLE
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 317 WHITTEN LN
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-2145
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Country | US
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Telephone | 304-455-1562
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Fax | 304-455-4955
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Provider Business Mailing Address
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Address Line | 317 WHITTEN LN
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-2145
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Country | US
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Telephone | 304-455-1562
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Fax | 304-455-4955
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Authorized Official
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Title or Position | PODIATRIST
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Name | PHILLIP KENNETH SLAMPAK
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Credential |
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Telephone | 304-455-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 339
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License Number State | WV
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