MEDICARE: THOMAS FOOT AND ANKLE PLLC

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	213E00000X	Podiatrist	215	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	$$$$$$$$$	OTHER	OK	STATE SSN

General Provider Information

NPI Number	:	1366859423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS FOOT AND ANKLE PLLC

Provider Business Mailing Address
First Line	:	5300 N GRAND BLVD
Second Line	:	SUITE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5647
Country	:	US
Telephone Number	:	405-943-6200
Fax Number	:	405-943-0080

Provider Business Practice Location Address
First Line	:	5300 N GRAND BLVD
Second Line	:	SUITE 300
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5647
Country	:	US
Telephone Number	:	405-943-6200
Fax Number	:	405-943-0080

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANA MCKEKENZIE
Credential	:
Telephone Number	:	405-943-6200

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	05/21/2020

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