Provider Demographics
NPI:1225377930
Name:WASATCH FOOT & ANKLE INSTITUTE, LLC
Entity Type:Organization
Organization Name:WASATCH FOOT & ANKLE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-867-7891
Mailing Address - Street 1:955 CHAMBERS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4595
Mailing Address - Country:US
Mailing Address - Phone:801-627-2122
Mailing Address - Fax:801-627-2125
Practice Address - Street 1:955 CHAMBERS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4595
Practice Address - Country:US
Practice Address - Phone:801-627-2122
Practice Address - Fax:801-627-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5461147-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty