Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
MOUNTAIN CREST FOOT AND ANKLE PA
Active
Organization
MOUNTAIN CREST FOOT AND ANKLE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ROGER BLACK DPM (OWNER/PHYSICIAN)
(208) 528-8700
Entity
Organization
Contact information
Practice address
3652 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 528-8700
(208) 528-2802
Mailing address
3652 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 528-8700
(208) 528-2802
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P-169
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806462800
—
ID
Enumeration date
08/16/2005
Last updated
12/06/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up