Provider Demographics
NPI:1225208127
Name:DARRELL D. PRINS
Entity Type:Organization
Organization Name:DARRELL D. PRINS
Other - Org Name:LINCOLN COUNTY FOOT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRINS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-994-2222
Mailing Address - Street 1:3011 NE WEST DEVILS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-5131
Mailing Address - Country:US
Mailing Address - Phone:541-994-2222
Mailing Address - Fax:
Practice Address - Street 1:130 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3132
Practice Address - Country:US
Practice Address - Phone:541-574-9464
Practice Address - Fax:541-996-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00257213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR107166Medicare PIN
OR1037040002Medicare NSC