Provider Demographics
NPI:1669857181
Name:CENTRAL OREGON FOOT & ANKLE GROUP, INC.
Entity Type:Organization
Organization Name:CENTRAL OREGON FOOT & ANKLE GROUP, INC.
Other - Org Name:CENTRAL OREGON FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-728-0858
Mailing Address - Street 1:1693 SW CHANDLER AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3231
Mailing Address - Country:US
Mailing Address - Phone:541-728-0858
Mailing Address - Fax:844-622-7945
Practice Address - Street 1:1693 SW CHANDLER AVE STE 280
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3231
Practice Address - Country:US
Practice Address - Phone:541-728-0858
Practice Address - Fax:844-622-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP125967213EP1101X
ORDP00439213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142443OtherMEDICARE PTAN
OR026196Medicaid
OR50061912Medicaid
ORR149663OtherMEDICARE PTAN
ORR149663OtherMEDICARE PTAN