Provider Demographics
NPI:1508117698
Name:GLACIER PODIATRY CLINICS LLC
Entity Type:Organization
Organization Name:GLACIER PODIATRY CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUFFMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-285-8900
Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-285-8900
Mailing Address - Fax:405-285-8921
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:SUITE 400B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-285-8900
Practice Address - Fax:405-285-8921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLACIER HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK125213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty