Provider Demographics
NPI:1164543591
Name:EDWARD A. CLINE, DPM, PC
Entity Type:Organization
Organization Name:EDWARD A. CLINE, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:573-221-3266
Mailing Address - Street 1:109 VIRGINIA ST
Mailing Address - Street 2:SUITE 278
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3778
Mailing Address - Country:US
Mailing Address - Phone:573-221-3266
Mailing Address - Fax:573-221-8066
Practice Address - Street 1:109 VIRGINIA ST
Practice Address - Street 2:SUITE 278
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3778
Practice Address - Country:US
Practice Address - Phone:573-221-3266
Practice Address - Fax:573-221-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0000745213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30963700016Medicaid
MO117516OtherBLUE CROSS AND BLUE SHIEL
MO30963700016Medicaid