Provider Demographics
NPI:1003238700
Name:ON-SITE PODIATRY, INC
Entity Type:Organization
Organization Name:ON-SITE PODIATRY, INC
Other - Org Name:PINNACLE FOOT AND ANKLE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:763-545-7545
Mailing Address - Street 1:5201 EDEN AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1805 HENNEPIN AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1416
Practice Address - Country:US
Practice Address - Phone:952-890-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN750213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty