MEDICARE: SANTIAM FOOT 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	213E00000X	Podiatrist	DP00297	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	:	1528395043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTIAM FOOT CLINIC, PC

Provider Business Mailing Address
First Line	:	2235 MISSION ST SE STE 150
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1294
Country	:	US
Telephone Number	:	503-581-2505
Fax Number	:	503-581-2515

Provider Business Practice Location Address
First Line	:	2235 MISSION ST SE STE 150
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-1294
Country	:	US
Telephone Number	:	503-581-2505
Fax Number	:	503-581-2515

Authorized Official
Title or Position	:	PODIATRIC PHYSICIAN AND SURGEON
Name	:	DR. JOHN THOMAS CALLAHAN
Credential	:	DPM
Telephone Number	:	503-581-2505

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	05/26/2010

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Directions to “SANTIAM FOOT CLINIC, PC ” Practice Location

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