Wilde Foot & Ankle Clinic PA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

1200315 Issued in KS

Legal business name

WILDE FOOT & ANKLE CLINIC PA

Practice address

407 E Centennial Dr
Pittsburg, KS 66762-6505

Phone

(620) 231-5940

Fax

(620) 231-5948

NPI assigned

Apr 16, 2007

Last updated

May 4, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Corin Q Wilde, DPMNPI 1285616375

Title

Owner

Phone

(620) 231-5940

Specialties & licenses 1

Addresses

Other names 1

• Southeast Kansas Foot Clinic PA Former legal business name

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corin Q Wilde, DPM

  • Foot & Ankle Surgery Podiatrist
  • Pittsburg, KS
  • NPI 1285616375
  Medicare reassignment NPD Authorized official
• Travis Smardo Sr., CPED

  • Pedorthist
  • Pittsburg, KS
  • NPI 1588478424
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1225253305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-231-5940",
            "fax_number": "620-231-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-231-5940",
            "fax_number": "620-231-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDE FOOT & ANKLE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "CORIN",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-231-5940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KS",
            "license": "1200315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Kansas Foot Clinic PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Titus Jack Weller, M.D.
• Lisa Wells, PHARMD
• Brandi Paige Whetzell, DNP
• Gentry A. White, M.A. CCC-SLP
• James Currah Whitford, PT
• Corin Q Wilde, DPM
• Ruth Wilkinson, DMD
• Kyle E Willard
• Krista Lynn Williams-Mijares, MD
• Christopher M Wilson, PT

• Foot & Ankle Surgery Podiatrist in Pittsburg, KS
• Providers in Pittsburg, KS by specialty
• Foot & Ankle Surgery Podiatrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.