Tri Lakes Podiatry PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

2000165040 Issued in MO

Legal business name

TRI LAKES PODIATRY PC

Practice address

105 S Ridgecrest Ave
Nixa, MO 65714-7807

Phone

(417) 724-3100

Fax

(417) 725-2985

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Jeffrey P Korte, DPM

Title

Owner Doctor

Phone

(417) 725-9995

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275758351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "address_2": "300 WEST MT VERNON SUITE G",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657140870",
            "telephone_number": "417-725-9995",
            "fax_number": "417-725-2985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S RIDGECREST AVE",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657147807",
            "telephone_number": "417-724-3100",
            "fax_number": "417-725-2985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI LAKES PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KORTE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "417-725-9995",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MO",
            "license": "2000165040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00294967",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Nixa, MO
• Providers in Nixa, MO by specialty
• Podiatrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.