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General NPI Number Information
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NPI Number | 1912049248
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Entity Type | Organization
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Legal Business Name | MADISON FOOT & ANKLE CARE, PA
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 25 MADISON PROFESSIONAL PARK
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City | REXBURG
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State | ID
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Zip | 83440-2057
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Country | US
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Telephone | 208-359-1400
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Fax | 208-356-3387
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Provider Business Mailing Address
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Address Line | 25 MADISON PROFESSIONAL PARK
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City | REXBURG
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State | ID
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Zip | 83440-2057
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Country | US
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Telephone | 208-359-1400
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Fax | 208-356-3387
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | MRS. TERRI L BARTON
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Credential |
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Telephone | 208-359-1400
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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 | P-146
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License Number State | ID
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