Provider Demographics
NPI:1417019449
Name:HASTE PODIATRY CLINICS P C
Entity Type:Organization
Organization Name:HASTE PODIATRY CLINICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HASTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-659-9395
Mailing Address - Street 1:1617 W 26TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0368
Mailing Address - Country:US
Mailing Address - Phone:417-659-9395
Mailing Address - Fax:417-659-9695
Practice Address - Street 1:1617 W 26TH ST STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0368
Practice Address - Country:US
Practice Address - Phone:417-659-9395
Practice Address - Fax:417-659-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626280101Medicaid
MODN6307OtherMEDICARE RR
MO5441720001Medicare NSC
MO626280101Medicaid