Provider Demographics
NPI:1386653368
Name:SMITH FOOT CLINIC PC
Entity Type:Organization
Organization Name:SMITH FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-752-4639
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:311 W MAIN ST
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-0879
Mailing Address - Country:US
Mailing Address - Phone:641-752-4639
Mailing Address - Fax:641-752-2164
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-0879
Practice Address - Country:US
Practice Address - Phone:641-752-4639
Practice Address - Fax:641-752-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3265694Medicaid
U01720Medicare UPIN
IA3265694Medicaid
IA5596930001Medicare NSC
IAI16715Medicare PIN