Provider Demographics
NPI:1619005865
Name:OK FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:OK FOOT & ANKLE SPECIALISTS
Other - Org Name:OKLAHOMA FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-691-9004
Mailing Address - Street 1:9315 S PENNSYLVANIA AVE STE A
Mailing Address - Street 2:OKLAHOMA FOOT & ANKLE SPECIALISTS
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6913
Mailing Address - Country:US
Mailing Address - Phone:405-691-9004
Mailing Address - Fax:405-691-9003
Practice Address - Street 1:9315 S PENNSYLVANIA AVE
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6913
Practice Address - Country:US
Practice Address - Phone:405-691-9004
Practice Address - Fax:405-691-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK233213ES0103X
OK289213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200034090BMedicaid
OK200330230AMedicaid
OKV00296Medicare UPIN
OK900522176Medicare PIN
OK200034090BMedicaid
OK1962566307Medicare NSC
OK1427206077Medicare NSC