REGIONAL FOOT AND ANKLE, LLC (NPI# 1417113176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417113176 |
| Entity Type | Organization |
| Organization Name | REGIONAL FOOT AND ANKLE, LLC |
| Practice Address |
785 E Drake St Bolivar MO 65613-2739 |
| Practice Telephone | 4173266200 |
| Practice Fax Number | 4177777463 |
| Mailing Telephone | 4173266200 |
| Mailing Fax Number | 4177777463 |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2009-09-24 |
| Authorized Official Name | DR. MATT CLAYTON GARRISON (CO-OWNER) |
| Authorized Official Telephone | 4173266200 |
| Authorized Official Credential | D.P.M. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
2005017337 | MO | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 307420505 | 05 |
| Street Address |
785 E DRAKE ST |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-2739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588085278 | Alpha-omega Orthotics & Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 785 E Drake St, Bolivar, MO 65613-2739 | 2013-12-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144753492 | Creighton Woolsey | Podiatrist | 1155 W Parkview St Ste 2j, Bolivar, MO 65613-8598 | 2017-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851923023 | Center for Advanced Foot & Ankle Surgery, Inc. | Podiatrist | 3915 Watson Rd Ste 200, Saint Louis, MO 63109-1251 | 2020-02-06 |
| 1518486885 | Sunflower Podiatry and Wellness | Podiatrist | 1316 Hebert Street, Saint Louis, MO 63107 | 2017-09-18 |
| 1457701559 | Robert Austin Djali | Podiatrist | 1224 Graham Rd Ste 3010, Florissant, MO 63031-8028 | 2016-06-20 |
| 1770978074 | Shelly Diane Sedberry | Podiatrist | 1801 W 32nd St Bldg C, Joplin, MO 64804 | 2015-04-02 |
| 1376936591 | Corey Bess | Podiatrist | 1010 Carondelet Dr Ste 301, Kansas City, MO 64114 | 2015-03-12 |
| 1093117335 | True Health Integration and Synergy | Podiatrist | 6311 Ronald Reagan Dr, #167, Lake St Louis, MO 63367-2681 | 2014-09-18 |
| 1710305677 | Kevin M Renner | Podiatrist | 225 Physicians Park Ste 102, Poplar Bluff, MO 63901-3918 | 2014-03-28 |
| 1134474554 | Rajan K Patel | Podiatrist | 3930 S Jackson Dr, Apt 308, Independence, MO 64057-1706 | 2012-07-23 |
| 1720346307 | Feet for Life Centers Inc PC | Podiatrist | 17201 Chesterfield Airport Rd, Chesterfield, MO 63005-1423 | 2012-05-02 |
| 1669745501 | West County Foot and Ankle LLC | Podiatrist | 10004 Kennerly Rd Ste 300a, Saint Louis, MO 63128 | 2012-02-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.