Park City Pedorthics

Primary specialty

PedorthistTaxonomy code 224L00000X

Legal business name

PARK CITY PEDORTHICS

Practice address

902 E 1St St
Merrill, WI 54452-2508

Phone

(715) 203-5730

NPI assigned

Nov 22, 2019

Organization subpart

No

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

Authorized official

Name

Ms. Tasha Gleason, C.PEDNPI 1427616242

Title

Owner

Phone

(715) 203-5730

Specialties & licenses 2

Addresses

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.

• Tasha Marie Gleason

  • Pedorthist
  • Merrill, WI
  • NPI 1427616242
  Authorized official Same address or phone

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1407492671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 E 1ST ST",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "544522508",
            "telephone_number": "715-203-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 E 1ST ST",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "544522508",
            "telephone_number": "715-203-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CITY PEDORTHICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "GLEASON",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-203-5730",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "C.PED"
    },
    "taxonomies": [
        {
            "code": "224L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pedorthist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pedorthist in Merrill, WI
• Providers in Merrill, WI by specialty
• Pedorthist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.