Provider Demographics
NPI:1578546826
Name:MCKENZIE RIVER FOOT CLINIC LLC
Entity Type:Organization
Organization Name:MCKENZIE RIVER FOOT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MUHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:841-345-8111
Mailing Address - Street 1:911 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-345-8111
Mailing Address - Fax:541-345-8864
Practice Address - Street 1:911 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-345-8111
Practice Address - Fax:541-345-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO00286213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
121765Medicare ID - Type Unspecified
U70211Medicare UPIN