MEDICARE: OJAI FAMILY PODIATRY CLINIC INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E4302	CA

General Provider Information

NPI Number	:	1487829289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OJAI FAMILY PODIATRY CLINIC INC

Provider Business Mailing Address
First Line	:	115 PIRIE RD
Second Line	:	SUITE A
City	:	OJAI
State	:	CA
Zip	:	93023-3100
Country	:	US
Telephone Number	:	805-646-7163
Fax Number	:	805-646-7164

Provider Business Practice Location Address
First Line	:	115 PIRIE RD
Second Line	:	SUITE A
City	:	OJAI
State	:	CA
Zip	:	93023-3100
Country	:	US
Telephone Number	:	805-646-7163
Fax Number	:	805-646-7164

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES TODD BEATY
Credential	:	D.P.M
Telephone Number	:	805-646-7163

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	06/10/2010

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