Provider Demographics
NPI:1245365154
Name:BIG HORN FOOT CLINIC PC
Entity type:Organization
Organization Name:BIG HORN FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:LAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEACHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:307-754-9191
Mailing Address - Street 1:777 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2260
Mailing Address - Country:US
Mailing Address - Phone:307-754-9191
Mailing Address - Fax:307-954-1291
Practice Address - Street 1:777 AVENUE H
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2260
Practice Address - Country:US
Practice Address - Phone:307-754-9191
Practice Address - Fax:307-954-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WY139213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307844OtherBLUE CROSS BLUE SHIELD #
WY113976200Medicaid
WY133719000Medicaid
WY1114923463OtherNPI# D. HUGH FRASER DPM
1922241181OtherDR. BEACHLER'S NPI
WY307844OtherBLUE CROSS BLUE SHIELD #
WY480027493Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
0211460001Medicare NSC
WYW307844Medicare PIN
WY113976200Medicaid