Provider Demographics
NPI:1245568427
Name:COUNCIL BLUFFS FOOT & ANKLE CARE PC
Entity Type:Organization
Organization Name:COUNCIL BLUFFS FOOT & ANKLE CARE PC
Other - Org Name:COUNCIL BLUFFS FOOT & ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-328-0297
Mailing Address - Street 1:320 MCKENZIE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-328-0297
Mailing Address - Fax:712-328-2403
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-328-0297
Practice Address - Fax:712-328-2403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1587Medicare PIN
NENA1444Medicare PIN
IA6332820001Medicare NSC