MEDICARE: FOOT & ANKLE CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	DP00131	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE CLINIC PC

Provider Business Mailing Address
First Line	:	1050 SW 3RD AVE
Second Line	:	STE 600
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-881-1319
Fax Number	:	541-881-1238

Provider Business Practice Location Address
First Line	:	1050 SW 3RD AVE
Second Line	:	STE 600
City	:	ONTARIO
State	:	OR
Zip	:	97914-2193
Country	:	US
Telephone Number	:	541-881-1319
Fax Number	:	541-881-1238

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN KEITH PARRIS
Credential	:	DPM
Telephone Number	:	541-881-1319

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/30/2008

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Directions to “FOOT & ANKLE CLINIC PC ” Practice Location

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