Organization
SOUTWEST PODIATRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSIE M AKER (OFFICE MANAGER)
(276) 228-2212
Entity
Organization
Contact information
Practice address
680 W MONROE ST, WYTHEVILLE, VA 24382-2240
(276) 228-2212
(276) 228-7835
Mailing address
680 W MONROE ST, WYTHEVILLE, VA 24382-2240
(276) 228-2212
(276) 228-7835
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000769
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0975940001
ADMINISTAR FEDERAL
VA
01
—
101905
ANTHEM GROUP
VA
01
—
CI5929
RR MEDICARE
VA
Enumeration date
05/26/2006
Last updated
10/29/2013
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