OrganizationActive
Mountain Crest Foot and Ankle PA
NPI 1932191996 · Podiatrist · Idaho Falls, ID
Provider details
- NPI number
- 1932191996
- Entity type
- Organization
- Primary specialty
- PodiatristPodiatric Medicine & Surgery Service Providers
- Organization subpart
- No
- Authorized official
- Timothy Black, Owner/Physician(208) 528-8700
- License
- P-169 (ID)
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
Practice location
3652 Washington Pkwy
Idaho Falls, ID 83404-7573
Phone: (208) 528-8700
Fax: (208) 528-2802
Approximate (ZIP-level) locationGet directions
Mailing address
3652 Washington Pkwy
Idaho Falls, ID 83404-7573
Registry dates
- Enumerated
- 2005-08-16
- Last updated
- 2010-12-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.