Provider Demographics
NPI:1063786077
Name:ANKLE & FOOT CARE CLINIC, PC
Entity type:Organization
Organization Name:ANKLE & FOOT CARE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-721-1171
Mailing Address - Street 1:2831 FORT MISSOULA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7401
Mailing Address - Country:US
Mailing Address - Phone:406-721-1171
Mailing Address - Fax:406-721-0622
Practice Address - Street 1:2831 FORT MISSOULA RD STE 302
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7401
Practice Address - Country:US
Practice Address - Phone:406-721-1171
Practice Address - Fax:406-721-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT88332B00000X, 332BC3200X, 335E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier