Provider Demographics
NPI:1447676697
Name:WALNUT VALLEY FOOT AND ANKLE PA
Entity type:Organization
Organization Name:WALNUT VALLEY FOOT AND ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-477-2584
Mailing Address - Street 1:1230 E 6TH AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3145
Mailing Address - Country:US
Mailing Address - Phone:484-477-2584
Mailing Address - Fax:
Practice Address - Street 1:1230 E 6TH AVE
Practice Address - Street 2:STE 2A
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3143
Practice Address - Country:US
Practice Address - Phone:620-221-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00399213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty