Provider Demographics
NPI:1073979845
Name:CAPITAL FOOT AND ANKLE
Entity Type:Organization
Organization Name:CAPITAL FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-864-1708
Mailing Address - Street 1:PO BOX 1952
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-1952
Mailing Address - Country:US
Mailing Address - Phone:515-864-1708
Mailing Address - Fax:
Practice Address - Street 1:136 W EDMONTON DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0224
Practice Address - Country:US
Practice Address - Phone:515-864-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND79213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty