SANTA FE FOOT AND ANKLE INSTITUTE, LLC

Provider Demographics

• NPI: 1093042632
• Name: SANTA FE FOOT AND ANKLE INSTITUTE, LLC
• Entity Type: Organization
• Organization Name: SANTA FE FOOT AND ANKLE INSTITUTE, LLC
• Authorized Official - Title/Position: MEMBER/OWNER
• Authorized Official - First Name: GLENDA
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: KING
• Authorized Official - Credentials: DPM
• Authorized Official - Phone: 505-988-3338
• Mailing Address - Street 1: 2019 GALISTEO ST
• Mailing Address - Street 2: UNIT A4
• Mailing Address - City: SANTA FE
• Mailing Address - State: NM
• Mailing Address - Zip Code: 87505-2143
• Mailing Address - Country: US
• Mailing Address - Phone: 505-988-3338
• Mailing Address - Fax: 505-982-3668
• Practice Address - Street 1: 2019 GALISTEO ST
• Practice Address - Street 2: UNIT A4
• Practice Address - City: SANTA FE
• Practice Address - State: NM
• Practice Address - Zip Code: 87505-2143
• Practice Address - Country: US
• Practice Address - Phone: 505-988-3338
• Practice Address - Fax: 505-982-3668
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-11-03
• Last Update Date: 2015-06-14

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	213ES0103X	Podiatric Medicine & Surgery Service Providers	Podiatrist	Foot & Ankle Surgery	Group - Single Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NM	1730266032	Other	IND NPI
NM	4781043	Other	CIGNA
NM	DR8662	Other	RR MCARE GROUP PIN
NM	9558062	Other	AETNA
NM	01331752	Other	AMERIGROUP
NM	85207578	Medicaid
NM	NM296	Other	NM LICENSE
NM	NM296	Other	NM LICENSE
NM	1730266032	Other	IND NPI
NM	V00563	Medicare UPIN