Provider Demographics
NPI:1699869149
Name:AMERICAN FOOT CLINIC INC
Entity type:Organization
Organization Name:AMERICAN FOOT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:IX
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-733-2783
Mailing Address - Street 1:5480 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-5517
Mailing Address - Country:US
Mailing Address - Phone:405-733-2783
Mailing Address - Fax:405-741-2804
Practice Address - Street 1:5480 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5517
Practice Address - Country:US
Practice Address - Phone:405-733-2783
Practice Address - Fax:405-741-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0126213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK481120770OtherRAILROAD MEDICARE
OK731193914001OtherBCBS
OK100116430AMedicaid
OK100116430AMedicaid
OK731193914001OtherBCBS