Provider Demographics
NPI:1275534885
Name:FAMILY FOOT AND ANKLE CLINIC, PA
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NOREM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-421-7300
Mailing Address - Street 1:3790 117TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2666
Mailing Address - Country:US
Mailing Address - Phone:763-421-7300
Mailing Address - Fax:763-421-3337
Practice Address - Street 1:3790 117TH LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2666
Practice Address - Country:US
Practice Address - Phone:763-421-7300
Practice Address - Fax:763-421-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1924011213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111898OtherUCARE
MN027300700Medicaid
MN7B213FAOtherBLUE CROSS BLUE SHIELD
MN33942OtherHEALTH PARTNERS
MN027300700Medicaid
MN1002520001Medicare NSC