Provider Demographics
NPI:1295743557
Name:CROTTY FOOT CLINIC P A
Entity type:Organization
Organization Name:CROTTY FOOT CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-452-6555
Mailing Address - Street 1:6600 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4064
Mailing Address - Country:US
Mailing Address - Phone:479-452-6555
Mailing Address - Fax:479-452-3894
Practice Address - Street 1:6600 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4064
Practice Address - Country:US
Practice Address - Phone:479-452-6555
Practice Address - Fax:479-452-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57925OtherMEDICARE GROUP
AR57925Medicare PIN
AR57925OtherMEDICARE GROUP