Provider Demographics
NPI:1841247632
Name:NORMAN FOOT AND ANKLE CLINIC PC
Entity type:Organization
Organization Name:NORMAN FOOT AND ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-317-2990
Mailing Address - Street 1:2553 S KELLY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3888
Mailing Address - Country:US
Mailing Address - Phone:405-285-7408
Mailing Address - Fax:405-340-7077
Practice Address - Street 1:2553 S KELLY AVE
Practice Address - Street 2:STE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3888
Practice Address - Country:US
Practice Address - Phone:405-285-7408
Practice Address - Fax:405-340-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522054Medicare ID - Type Unspecified
OK3903200001Medicare NSC