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General NPI Number Information
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NPI Number | 1649453887
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Entity Type | Organization
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Legal Business Name | COMPLETE FOOT AND ANKLE CENTER, LLC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 521 E YOUNG AVE
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City | WARRENSBURG
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State | MO
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Zip | 64093-1228
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Country | US
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Telephone | 660-429-2626
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Fax | 660-429-3356
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Provider Business Mailing Address
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Address Line | 521 E YOUNG AVE
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City | WARRENSBURG
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State | MO
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Zip | 64093-1228
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Country | US
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Telephone | 660-429-2626
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Fax | 660-429-3356
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. LINCOLN RANDALL NOWLIN
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Credential | DPM
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Telephone | 660-429-2626
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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 | MO000757
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License Number State | MO
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