MEDICARE: FOOT SURGICAL CENTER, P.C.

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	162	SD

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	:	1730356189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT SURGICAL CENTER, P.C.

Provider Business Mailing Address
First Line	:	3217 S CAROLYN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-0744
Country	:	US
Telephone Number	:	605-362-7997
Fax Number	:	605-362-7930

Provider Business Practice Location Address
First Line	:	3217 S CAROLYN AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-0744
Country	:	US
Telephone Number	:	605-362-7997
Fax Number	:	605-362-7930

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT JOSEPH HEATH
Credential	:	DPM
Telephone Number	:	605-362-7997

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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