Provider Demographics
NPI:1871751198
Name:SPRINGDALE FOOT SPECIALIST PA
Entity type:Organization
Organization Name:SPRINGDALE FOOT SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-751-3656
Mailing Address - Street 1:1213 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6313
Mailing Address - Country:US
Mailing Address - Phone:479-751-3656
Mailing Address - Fax:479-750-2221
Practice Address - Street 1:1213 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6313
Practice Address - Country:US
Practice Address - Phone:479-751-3656
Practice Address - Fax:479-750-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK121332B00000X
AR69332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106361717Medicaid
OK200052700AMedicaid
OK442460675OtherMEDICARE - OK
AR56364OtherPTAN
AR480032388OtherMCRR
OK442460675OtherMEDICARE - OK
0912890001Medicare NSC
AR106361717Medicaid