Provider Demographics
NPI:1285863183
Name:HAYDEN FAMILY FOOT AND ANKLE CLINIC, PLLC
Entity Type:Organization
Organization Name:HAYDEN FAMILY FOOT AND ANKLE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HIX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:509-879-9029
Mailing Address - Street 1:8944 N HESS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9183
Mailing Address - Country:US
Mailing Address - Phone:208-762-0909
Mailing Address - Fax:888-762-0909
Practice Address - Street 1:8944 N HESS ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9183
Practice Address - Country:US
Practice Address - Phone:208-762-0909
Practice Address - Fax:888-762-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-200261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8084226Medicaid
ID1285863183Medicaid
ID13518001Medicare PIN
ID1285863183Medicaid