=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568840882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE FOOT & ANKLE INSTITUTE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2015
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13401 N WESTERN AVE SUITE 405
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73114-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-402-4513
-----------------------------------------------------
Fax | 888-494-3236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13401 N WESTERN AVE SUITE 405
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73114-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-402-4513
-----------------------------------------------------
Fax | 888-494-3236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | CARRIE GUENTHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-394-1169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 311
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------