Provider Demographics
NPI:1093919631
Name:BARRETT FOOT & ANKLE CENTER PHOENIX LLC
Entity Type:Organization
Organization Name:BARRETT FOOT & ANKLE CENTER PHOENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-586-6778
Mailing Address - Street 1:4131 DIRECTORS ROW
Mailing Address - Street 2:PO BOX 925919
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8703
Mailing Address - Country:US
Mailing Address - Phone:713-586-6778
Mailing Address - Fax:
Practice Address - Street 1:9377 E BELL RD
Practice Address - Street 2:SUITE 131
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1502
Practice Address - Country:US
Practice Address - Phone:480-473-1901
Practice Address - Fax:480-567-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0557207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID