Provider Demographics
NPI:1245379049
Name:PALO VERDE FOOT & ANKLE P L L C
Entity Type:Organization
Organization Name:PALO VERDE FOOT & ANKLE P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-758-3338
Mailing Address - Street 1:3003 HIGHWAY 95 STE 41
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7896
Mailing Address - Country:US
Mailing Address - Phone:928-758-3338
Mailing Address - Fax:928-758-4772
Practice Address - Street 1:3003 HIGHWAY 95 STE 41
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7896
Practice Address - Country:US
Practice Address - Phone:928-758-3338
Practice Address - Fax:928-758-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4416440001Medicare NSC
AZZ67548Medicare PIN