Provider Demographics
NPI:1093135634
Name:ANKLE & FOOT MEDICAL CENTER PC
Entity Type:Organization
Organization Name:ANKLE & FOOT MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-344-3324
Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6109
Mailing Address - Country:US
Mailing Address - Phone:208-344-3324
Mailing Address - Fax:208-344-4349
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-344-3324
Practice Address - Fax:208-344-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty