Provider Demographics
NPI:1275630451
Name:PREMIER FOOT AND ANKLE, L.L.C.
Entity Type:Organization
Organization Name:PREMIER FOOT AND ANKLE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-772-5916
Mailing Address - Street 1:PO BOX 26488
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6488
Mailing Address - Country:US
Mailing Address - Phone:928-772-5916
Mailing Address - Fax:928-775-3250
Practice Address - Street 1:3149 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2240
Practice Address - Country:US
Practice Address - Phone:928-772-5916
Practice Address - Fax:928-775-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0564213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00198294OtherRAIL ROAD MEDICARE
AZDC9191OtherRAIL RD MEDICARE
AZ711144001Medicaid
AZ711144002Medicaid
AZAZ0195490OtherBLUE CROSS BLUE SHIELD
AZ=========OtherAETNA
AZDC9191OtherRAIL RD MEDICARE
AZ711144001Medicaid