Provider Demographics
NPI:1831217082
Name:WOODWARD FOOT CLINIC PLLC
Entity type:Organization
Organization Name:WOODWARD FOOT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:S
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-256-8603
Mailing Address - Street 1:1712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2939
Mailing Address - Country:US
Mailing Address - Phone:580-256-8603
Mailing Address - Fax:580-256-8604
Practice Address - Street 1:1712 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2939
Practice Address - Country:US
Practice Address - Phone:580-256-8603
Practice Address - Fax:580-256-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK127213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDG6805OtherPALMETTO GBA
OK200117750AMedicaid
OK200117750BMedicaid
OK200117750BMedicaid
OK6067780001Medicare NSC
OK900522595Medicare PIN