Provider Demographics
NPI:1619154143
Name:CENTRAL MISSOURI PODIATRY INC
Entity Type:Organization
Organization Name:CENTRAL MISSOURI PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIKOUTRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:660-827-6311
Mailing Address - Street 1:1701 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7541
Mailing Address - Country:US
Mailing Address - Phone:660-827-6311
Mailing Address - Fax:660-827-5183
Practice Address - Street 1:1701 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7541
Practice Address - Country:US
Practice Address - Phone:660-827-6311
Practice Address - Fax:660-827-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4740660001Medicare NSC