Provider Demographics
NPI:1811180615
Name:CANYON FOOT & ANKLE SPECIALISTS PC
Entity type:Organization
Organization Name:CANYON FOOT & ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-733-0436
Mailing Address - Street 1:PO BOX 5577
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303
Mailing Address - Country:US
Mailing Address - Phone:208-733-0436
Mailing Address - Fax:208-733-0438
Practice Address - Street 1:676 SHOUP AVE W
Practice Address - Street 2:SUITE 12
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4615
Practice Address - Country:US
Practice Address - Phone:208-733-0436
Practice Address - Fax:208-733-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-187261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807346000Medicaid
ID1369188OtherMEDICARE PROVIDER
D08608980OtherMEDICARE DME SUBITTER ID
IDP-2428OtherBLUE CROSS
IDP2427OtherBLUE CROSS
ID807346000Medicaid