Provider Demographics
NPI:1689837445
Name:FOOT AND ANKLE CLINIC OF STILLWATER LTD
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF STILLWATER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:CROTTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-743-3668
Mailing Address - Street 1:120 N PERKINS RD
Mailing Address - Street 2:STE A
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5524
Mailing Address - Country:US
Mailing Address - Phone:405-743-3668
Mailing Address - Fax:405-743-1718
Practice Address - Street 1:120 N PERKINS RD
Practice Address - Street 2:STE A
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5524
Practice Address - Country:US
Practice Address - Phone:405-743-3668
Practice Address - Fax:405-743-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK167332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
480179134OtherRAILROAD MEDICARE
OK731313428001OtherBLUE CROSS BLUE SHIELD
OK0220270001Medicare NSC
OKOKAAA3569Medicare PIN
OK731313428001OtherBLUE CROSS BLUE SHIELD