Provider Demographics
NPI:1346268315
Name:NEO FOOT AND ANKLE INC
Entity Type:Organization
Organization Name:NEO FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-540-7655
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-1323
Mailing Address - Country:US
Mailing Address - Phone:918-540-7655
Mailing Address - Fax:918-540-7668
Practice Address - Street 1:310 2ND AVE SW
Practice Address - Street 2:STE 102
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6708
Practice Address - Country:US
Practice Address - Phone:918-540-7655
Practice Address - Fax:918-540-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK223261QM2500X, 332B00000X
OK0058567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200049560AMedicaid
OK200049560AMedicaid
OK1346268315Medicare Oscar/Certification
OK6023490001Medicare NSC