Provider Demographics
NPI:1457520835
Name:CASPER FOOT CLINIC
Entity Type:Organization
Organization Name:CASPER FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:307-266-4415
Mailing Address - Street 1:1916 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2777
Mailing Address - Country:US
Mailing Address - Phone:307-266-4415
Mailing Address - Fax:307-472-4414
Practice Address - Street 1:1916 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2777
Practice Address - Country:US
Practice Address - Phone:307-266-4415
Practice Address - Fax:307-472-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9539Medicare PIN
WY4728970001Medicare NSC