Provider Demographics
NPI:1033258918
Name:FAMILY FOOT & ANKLE CLINIC PC
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:701-258-8120
Mailing Address - Street 1:525 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4510
Mailing Address - Country:US
Mailing Address - Phone:701-258-8120
Mailing Address - Fax:701-222-0229
Practice Address - Street 1:525 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4510
Practice Address - Country:US
Practice Address - Phone:701-258-8120
Practice Address - Fax:701-222-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17217Medicaid
ND0653340001Medicare NSC