Provider Demographics
NPI:1093374464
Name:VALLEY FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:VALLEY FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-815-6862
Mailing Address - Street 1:104 MARGARET LN STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5261
Mailing Address - Country:US
Mailing Address - Phone:530-648-1234
Mailing Address - Fax:530-648-1235
Practice Address - Street 1:104 MARGARET LN STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5261
Practice Address - Country:US
Practice Address - Phone:530-648-1234
Practice Address - Fax:530-648-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty