Eastern Idaho Foot Clinic

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

P126 Issued in ID

Legal business name

EASTERN IDAHO FOOT CLINIC

Practice address

2565 Channing Way
Idaho Falls, ID 83404-7516

Phone

(208) 523-2928

Fax

(208) 523-2962

NPI assigned

Nov 17, 2009

Last updated

Nov 17, 2009By 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. Jerry D. Cooper, D.P.M.NPI 1942299151

Title

Owner

Phone

(208) 523-2928

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Jerry D Cooper, D.P.M.

  • Podiatrist
  • Idaho Falls, ID
  • NPI 1942299151
  Authorized official Same address or phone

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1225365992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2565 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047516",
            "telephone_number": "208-523-2928",
            "fax_number": "208-523-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047516",
            "telephone_number": "208-523-2928",
            "fax_number": "208-523-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN IDAHO FOOT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-523-2928",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": "P126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001393600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Idaho Youth Homes LLC
• Eastern Idaho Cardiology Associates, PLLC
• Eastern Idaho Chiropractic Clinic PA
• Eastern Idaho Community Action Partnership
• Eastern Idaho Endodontics
• Eastern Idaho Health Services Inc (Eastern Idaho Regional Medical Center)
• Eastern Idaho Health Services Inc (Eastern Idaho Regional Medical Center)
• Eastern Idaho Health Services, Inc (Eastern Idaho Neurology)
• Eastern Idaho Health Services, Inc (Eastern Idaho Critical Care)
• Eastern Idaho Health Services, Inc. (Eastern Idaho Regional Medical Center Transitional Care Unit)

• Durable Medical Equipment & Medical Supplies in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Durable Medical Equipment & Medical Supplies in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.