Provider Demographics
NPI:1164528212
Name:ADVANCED FOOT CLINIC, PC
Entity Type:Organization
Organization Name:ADVANCED FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARABSHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-391-0688
Mailing Address - Street 1:PO BOX 23846
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3846
Mailing Address - Country:US
Mailing Address - Phone:503-391-0688
Mailing Address - Fax:503-625-8638
Practice Address - Street 1:1475 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4307
Practice Address - Country:US
Practice Address - Phone:503-932-0885
Practice Address - Fax:503-625-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00296213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158911Medicaid
OR480034478OtherPALMETTO GBA RAILROAD MED
ORR111524OtherMEDICARE
OR480034478OtherPALMTO GBA-RAILRD MEDICAR
OR5738490001OtherMEDICARE DME
ORR111524Medicare PIN