Provider Demographics
NPI:1366714867
Name:JOHN S BELKNAP
Entity type:Organization
Organization Name:JOHN S BELKNAP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-228-7106
Mailing Address - Street 1:1100 E MARINA WAY
Mailing Address - Street 2:SUITE 223
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2305
Mailing Address - Country:US
Mailing Address - Phone:541-386-1006
Mailing Address - Fax:541-386-1284
Practice Address - Street 1:1100 E MARINA WAY
Practice Address - Street 2:SUITE 223
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2305
Practice Address - Country:US
Practice Address - Phone:541-386-1006
Practice Address - Fax:541-386-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty