MEDICARE: OK FOOT & ANKLE SPECIALISTS

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
2	213ES0103X	Foot & Ankle Surgery Podiatrist	289	OK
3	213ES0103X	Foot & Ankle Surgery Podiatrist	233	OK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619005865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OK FOOT & ANKLE SPECIALISTS

Provider Business Mailing Address
First Line	:	9315 S PENNSYLVANIA AVE STE A
Second Line	:	OKLAHOMA FOOT & ANKLE SPECIALISTS
City	:	OKC
State	:	OK
Zip	:	73159-6913
Country	:	US
Telephone Number	:	405-691-9004
Fax Number	:	405-691-9003

Provider Business Practice Location Address
First Line	:	9315 S PENNSYLVANIA AVE
Second Line	:	STE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6913
Country	:	US
Telephone Number	:	405-691-9004
Fax Number	:	405-691-9003

Authorized Official
Title or Position	:	BILLING/CREDENTIALING
Name	:	KARI L. JOHNSON
Credential	:
Telephone Number	:	405-691-9004

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	04/20/2017

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Practice Location Address:

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Directions to “OK FOOT & ANKLE SPECIALISTS ” Practice Location

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