Provider Demographics
NPI:1326794355
Name:ROSEVILLE FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:ROSEVILLE FOOT AND ANKLE PC
Other - Org Name:ROSEVILLE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENTSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-300-9633
Mailing Address - Street 1:906 CIRBY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4475
Mailing Address - Country:US
Mailing Address - Phone:916-243-5033
Mailing Address - Fax:
Practice Address - Street 1:906 CIRBY WAY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4475
Practice Address - Country:US
Practice Address - Phone:916-300-9633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty