Organization
CANYON FOOT & ANKLE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORY PILLING DO (OWNER)
(208) 733-0436
Entity
Organization
Contact information
Practice address
676 SHOUP AVE W, SUITE 12, TWIN FALLS, ID 83301-4615
(208) 733-0436
(208) 733-0438
Mailing address
PO BOX 5577, TWIN FALLS, ID 83303
(208) 733-0436
(208) 733-0438
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
P-187
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369188
MEDICARE PROVIDER
ID
05
—
807346000
—
ID
01
—
D08608980
MEDICARE DME SUBITTER ID
—
01
—
P-2428
BLUE CROSS
ID
01
—
P2427
BLUE CROSS
ID
Enumeration date
08/24/2007
Last updated
08/21/2013
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