Provider Demographics
NPI:1467654897
Name:ADVANCED FOOT & ANKLE LTD
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:ANTHON
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-530-3230
Mailing Address - Street 1:PO BOX 10634
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0634
Mailing Address - Country:US
Mailing Address - Phone:928-530-3230
Mailing Address - Fax:
Practice Address - Street 1:1038 BRIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-7637
Practice Address - Country:US
Practice Address - Phone:928-530-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972510675OtherNPI FOR PROVIDER ONLY
AZ1467654897OtherGROUP NPI
AZ159782Medicaid
AZ1972510675OtherNPI FOR PROVIDER ONLY
AZU26397Medicare UPIN
AZ1168150001Medicare PIN
AZ159782Medicaid