Provider Demographics
NPI:1306816137
Name:ARKANSAS FOOT CLINIC, PA
Entity Type:Organization
Organization Name:ARKANSAS FOOT CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-224-1501
Mailing Address - Street 1:PO BOX 26508
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6501
Mailing Address - Country:US
Mailing Address - Phone:501-224-1501
Mailing Address - Fax:501-376-7065
Practice Address - Street 1:1501 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6611
Practice Address - Country:US
Practice Address - Phone:501-224-1501
Practice Address - Fax:501-376-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57258OtherBLUE ADVANTAGE
AR57258OtherAR BLUE CROSS
CD4794OtherRR MEDICARE
AR57258OtherHEALTH ADVANTAGE
AR57258OtherFIRST SOURCE PPO
AR57258OtherBCBS FEP
AR119019748Medicaid
AR57258OtherHEALTH ADVANTAGE
AR57258OtherBLUE ADVANTAGE
AR57258OtherFIRST SOURCE PPO