Provider Demographics
NPI:1275661795
Name:IOWA FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:IOWA FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELSANG
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-351-1100
Mailing Address - Street 1:2903 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9571
Mailing Address - Country:US
Mailing Address - Phone:319-351-1100
Mailing Address - Fax:319-351-2669
Practice Address - Street 1:2903 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9571
Practice Address - Country:US
Practice Address - Phone:319-351-1100
Practice Address - Fax:319-351-2669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00490213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0056564Medicaid
IADE1998OtherRRM
IADE1998OtherRRM
IA0175620001Medicare NSC