Provider Demographics
NPI:1528395043
Name:SANTIAM FOOT CLINIC, PC
Entity Type:Organization
Organization Name:SANTIAM FOOT CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC PHYSICIAN AND SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-581-2505
Mailing Address - Street 1:2235 MISSION ST SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1294
Mailing Address - Country:US
Mailing Address - Phone:503-581-2505
Mailing Address - Fax:503-581-2515
Practice Address - Street 1:2235 MISSION ST SE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1294
Practice Address - Country:US
Practice Address - Phone:503-581-2505
Practice Address - Fax:503-581-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138101Medicaid
ORU70991Medicare UPIN
R150066Medicare UPIN
OR138101Medicaid
OR6357250001Medicare NSC