Provider Demographics
NPI:1003091810
Name:BLACKWELL FEET PLUS, L.L.C.
Entity Type:Organization
Organization Name:BLACKWELL FEET PLUS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:918-762-3601
Mailing Address - Street 1:118 S 1ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-2830
Mailing Address - Country:US
Mailing Address - Phone:580-363-7255
Mailing Address - Fax:580-363-7265
Practice Address - Street 1:118 S 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2830
Practice Address - Country:US
Practice Address - Phone:580-363-7255
Practice Address - Fax:580-363-7265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1532261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center