Provider Demographics
NPI:1427001007
Name:LIMB SALVAGE INTERNATIONAL
Entity Type:Organization
Organization Name:LIMB SALVAGE INTERNATIONAL
Other - Org Name:LSI FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-458-9888
Mailing Address - Street 1:ONE PLAZA SOUTH
Mailing Address - Street 2:PMB 140
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-458-9888
Mailing Address - Fax:918-458-9977
Practice Address - Street 1:215 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-458-9888
Practice Address - Fax:918-458-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100849930BMedicaid
OK=========001OtherBCBS NUMBER
OK5329300001Medicare NSC
U63067Medicare UPIN
OK=========001OtherBCBS NUMBER
OK100849930BMedicaid