| NPI | 1033235783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP NEIL BURK President 208-466-3338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ID P-99) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ID P-99) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-08-25 |