OTTER TAIL PODIATRY ASSOCIATES, P.A. (NPI# 1639150774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639150774 |
| Entity Type | Organization |
| Organization Name | OTTER TAIL PODIATRY ASSOCIATES, P.A. |
| Practice Address |
120 E Junius Ave Fergus Falls MN 56537-2819 |
| Practice Telephone | 2187366868 |
| Practice Fax Number | 2187366017 |
| Mailing Telephone | 2187366868 |
| Mailing Fax Number | 2187366017 |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. KARENTHEA W. ROUW (CEO) |
| Authorized Official Telephone | 2187366868 |
| Authorized Official Credential | D.P.M. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBSMN | 3B099OT | 01 |
| Street Address |
120 E JUNIUS AVE |
| City | FERGUS FALLS |
| State | MN |
| Zip Code | 56537-2819 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912286964 | Otter Tail Podiatry P.C. | Podiatrist | 120 E Junius Ave, Fergus Falls, MN 56537-2819 | 2011-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295334217 | Mary Jane Andersen | Pharmacist | 3300 Hwy 210 W, Fergus Falls, MN 56537 | 2020-10-21 |
| 1609475615 | Blaine Perry Ecker | Pharmacist | 3300 Highway 210 W., 3300 Highway 210 West, Fergus Falls, MN 56537 | 2020-10-21 |
| 1336771591 | Paul George Wawin | Psychiatry & Neurology | 712 Cascade St. S. Lake Region Healthcare, Fergus Falls, MN 56537 | 2020-02-06 |
| 1134604127 | Christopher Michael Kjolhaug | Physical Therapist | 1131 South Mabelle Ave, Fergus Falls, MN 56537 | 2018-09-26 |
| 1619406808 | Aaron John Teigen | Physical Therapist | 1304 Lincoln Ave W, Suite C, Fergus Falls, MN 56537 | 2017-06-09 |
| 1003272154 | Anthony Gettel Dc LLC | Chiropractor | 755 Wildwood Trail, Fergus Falls, MN 56537 | 2016-01-05 |
| 1447628912 | Kelsey Shea | Student in an Organized Health Care Education/Training Program | 20743 Red Oak Dr., Fergus Falls, MN 56537 | 2015-09-14 |
| 1881070217 | Vineet Ganapati | Dentist | 2001 W Lincoln Ave # 33, Fergus Falls, MN 56537 | 2015-08-07 |
| 1497004832 | Beverly Renae Reiff | Registered Nurse | 22279 River Oaks Drive, Fergus Falls, MN 56537 | 2012-08-30 |
| 1114221421 | Jane Mary Bjornson | Social Worker | 21081 County Hwy 1, Fergus Falls, MN 56537 | 2010-12-29 |
| Find all providers in zip 56537 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700098613 | Winona Foot Clinic P.a. | Podiatrist | 350 East Sarnia Street, Winona, MN 55987 | 2007-05-04 |
| 1215149364 | John M Enger, Professional Association | Podiatrist | 904 E Plaza Street, Albert Lea, MN 56007 | 2007-05-03 |
| 1710083837 | Medical Arts Foot Clinics, P. A. | Podiatrist | 3485 Willow Lake Blvd, Suite 300, Saint Paul, MN 55110-5152 | 2006-09-16 |
| 1205856713 | Dale Herbert Vancil | Podiatrist | 3485 Willow Lake Blvd., Suite 300, Lino Lakes, MN 55110-5152 | 2006-07-20 |
| 1497145262 | David Edward Jones | Podiatrist | 5861 Cedar Lake Rd S, Minneapolis, MN 55416-1653 | 2015-01-30 |
| 1912271180 | Kari Prescott, D P M P A | Podiatrist | 825 Nicollet Mall, Suite 441, Minneapolis, MN 55402-2606 | 2012-03-05 |
| 1952612418 | Corey Edward Valentine | Podiatrist | 301 Highway 65 S, Mora, MN 55051-1899 | 2010-06-29 |
| 1053639732 | Melanie Johnson | Podiatrist | 4653 White Bear Pkwy, White Bear Lake, MN 55110 | 2010-05-05 |
| 1154559144 | Conrad L Meints & Associate | Podiatrist | 324 W Superior St, Suite 517, Duluth, MN 55802-1760 | 2009-06-29 |
| 1588870703 | Central Minnesota Foot & Ankle Associates,pa | Podiatrist | 1545 Northway Dr, Suite 130, Saint Cloud, MN 56303-1940 | 2007-05-15 |
| Find all providers with the same taxonomy | ||||
| City | FERGUS FALLS |
| Zip Code | 56537 |
Please comment or provide details below to improve the information on OTTER TAIL PODIATRY ASSOCIATES, P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.