Provider Demographics
NPI:1952591158
Name:VALLEY VIEW FOOT & ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:VALLEY VIEW FOOT & ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:580-599-0001
Mailing Address - Street 1:1631 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2639
Mailing Address - Country:US
Mailing Address - Phone:580-559-0001
Mailing Address - Fax:580-559-0002
Practice Address - Street 1:1631 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2639
Practice Address - Country:US
Practice Address - Phone:580-559-0001
Practice Address - Fax:580-559-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK253261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200119570AMedicaid
OK200119680AMedicaid
OK200119680AMedicaid
OK500522208Medicare PIN