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General NPI Number Information
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NPI Number | 1518327261
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Entity Type | Organization
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Legal Business Name | FLATHEAD FAMILY FOOT CARE PC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 715 NUCLEUS AVE
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-4015
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Country | US
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Telephone | 406-730-3669
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Fax | 406-730-3667
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Provider Business Mailing Address
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Address Line | 715 NUCLEUS AVE
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-4015
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Country | US
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Telephone | 406-730-3669
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Fax | 406-730-3667
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT CLASE
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Credential | DPM
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Telephone | 406-730-3669
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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 | 25643
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License Number State | MT
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