MOUNTAIN CREST FOOT AND ANKLE PA (NPI# 1932191996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932191996 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN CREST FOOT AND ANKLE PA |
| Practice Address |
3652 Washington Pkwy Idaho Falls ID 83404-7573 |
| Practice Telephone | 2085288700 |
| Practice Fax Number | 2085282802 |
| Mailing Telephone | 2085288700 |
| Mailing Fax Number | 2085282802 |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2010-12-06 |
| Authorized Official Name | DR. TIMOTHY ROGER BLACK (OWNER/PHYSICIAN) |
| Authorized Official Telephone | 2085288700 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | P-169 | ID | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 806462800 | 05 |
| Street Address |
3652 WASHINGTON PKWY |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-7573 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821637307 | Ascend Chiropractic Pllc | Chiropractor | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2019-12-31 |
| 1316487671 | Orange, LLC | Nurse Practitioner | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2017-03-06 |
| 1710352349 | Carmen Radford | Nurse Practitioner | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2015-12-08 |
| 1588038616 | Carmen Hernandez Radford | Public Health or Welfare | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2015-12-01 |
| 1336415769 | Orange LLC. | Nurse Practitioner | 3652 Washington Pkwy, Idaho Falls, ID 83404 | 2012-03-29 |
| 1578753091 | Timothy Roger Black | Podiatrist | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2007-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629111497 | Michael K. James | Podiatrist | 3345 S Holmes Ave, Idaho Falls, ID 83404-7981 | 2007-02-14 |
| 1790792216 | Charles Frank Call IIi | Podiatrist | 718 Beulahs Ln, Idaho Falls, ID 83401-2340 | 2006-08-01 |
| 1225065246 | Andrew L Mccall | Podiatrist | 2920 Cortez Ave, Idaho Falls, ID 83404-7554 | 2006-06-26 |
| 1205874914 | Therapeutic Shoes Inc | Podiatrist | 718 Beulahs Lane, Idaho Falls, ID 83401 | 2006-06-03 |
| 1942299151 | Jerry D Cooper | Podiatrist | 2565 Channing Way, Idaho Falls, ID 83404-7516 | 2005-10-19 |
| 1952654881 | Teton Foot & Ankle Center, PC | Podiatrist | 3345 S Holmes Ave, Idaho Falls, ID 83404-7981 | 2012-10-16 |
| 1578753091 | Timothy Roger Black | Podiatrist | 3652 Washington Pkwy, Idaho Falls, ID 83404-7573 | 2007-07-31 |
| 1134342256 | Andrew L Mccall Dpm Pa | Podiatrist | 2920 Cortez Ave, Idaho Falls, ID 83404-7554 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558968750 | Family Foot and Ankle of Idaho, LLC | Podiatrist | 349 W Bacall Dr, Meridian, ID 83646-7391 | 2020-10-01 |
| 1740824762 | Idaho Complete Foot Care | Podiatrist | 880 Redman St, Chubbuck, ID 83202-2655 | 2019-11-01 |
| 1346883261 | Monarch Medical LLC | Podiatrist | 423 N 3rd Ave Ste 110, Sandpoint, ID 83864-1511 | 2019-10-23 |
| 1326496910 | Advanced Foot & Ankle of Magic Valley, Pllc | Podiatrist | 176 Falls Ave Ste 200, Twin Falls, ID 83301-2306 | 2016-05-25 |
| 1629223110 | Kyle R. Yorgason | Podiatrist | 1075 N Curtis Rd Ste 300, Boise, ID 83706-1348 | 2008-11-25 |
| 1609085455 | Craig D Holman Chartered | Podiatrist | 496 Shoup Ave W # B, Twin Falls, ID 83301-5043 | 2007-05-21 |
| 1669516738 | Valley Foot & Ankle, PC | Podiatrist | 1455 Bench Rd Ste B, Pocatello, ID 83201-5084 | 2007-02-20 |
| 1790864619 | Valley Foot & Ankle, PC | Podiatrist | 1455 Bench Rd, Suite B, Pocatello, ID 83201 | 2006-11-02 |
| 1629185426 | Ronald Ray Vogel | Podiatrist | 12717 N Avondale Loop, Hayden, ID 83835-7531 | 2006-08-25 |
| 1063426948 | William Scott Stano | Podiatrist | 220 W Jefferson St, Boise, ID 83702-6044 | 2006-07-28 |
| Find all providers with the same taxonomy | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on MOUNTAIN CREST FOOT AND ANKLE PA.
| 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.