Provider Demographics
NPI:1366649204
Name:SPENCER FOOT AND ANKLE CLINIC INC
Entity Type:Organization
Organization Name:SPENCER FOOT AND ANKLE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:641-342-6054
Mailing Address - Street 1:110 E MCLANE ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1457
Mailing Address - Country:US
Mailing Address - Phone:641-342-6054
Mailing Address - Fax:641-342-2292
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2462
Practice Address - Fax:641-342-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00413332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55877OtherWELLMARK BLUE CROSS BLUE
IA4214171Medicaid
IAT01212Medicare UPIN
IA4214171Medicaid