Provider Demographics
NPI:1033235783
Name:FOOT & ANKLE MEDICAL CENTER OF NAMPA, P.A.
Entity Type:Organization
Organization Name:FOOT & ANKLE MEDICAL CENTER OF NAMPA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-466-3338
Mailing Address - Street 1:203 12TH AVE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5012
Mailing Address - Country:US
Mailing Address - Phone:208-466-3338
Mailing Address - Fax:208-466-3554
Practice Address - Street 1:203 12TH AVE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5012
Practice Address - Country:US
Practice Address - Phone:208-466-3338
Practice Address - Fax:208-466-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-99213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL808001900Medicaid
ID000010015689OtherREGENCE BLUE SHIELD
ID001519600Medicaid
IDP2446OtherBLUE CROSS
ID000010167550OtherREGENCE BLUE SHIELD
IDP2447OtherBLUE CROSS
IDP9371OtherBLUE CROSS
IDP9371OtherBLUE CROSS
IDP2447OtherBLUE CROSS
IDT44256Medicare UPIN
ID1100177Medicare PIN
IL808001900Medicaid