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.
Contact us