Provider Demographics
NPI:1255599395
Name:CORINTH PODIATRY GROUP
Entity type:Organization
Organization Name:CORINTH PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STENGER
Authorized Official - Suffix:
Authorized Official - Credentials:CERT SURGICAL TECH
Authorized Official - Phone:816-461-3535
Mailing Address - Street 1:4967 NE GOODVIEW CIR STE B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2493
Mailing Address - Country:US
Mailing Address - Phone:816-461-3535
Mailing Address - Fax:816-461-8782
Practice Address - Street 1:4967 NE GOODVIEW CIR STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2493
Practice Address - Country:US
Practice Address - Phone:816-461-3535
Practice Address - Fax:816-461-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000387213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4260000CMedicare PIN