Provider Demographics
NPI: | 1477678704 |
---|---|
Name: | ALLEN FOOT AND ANKLE MEDICINE AND SURGERY PLC |
Entity Type: | Organization |
Organization Name: | ALLEN FOOT AND ANKLE MEDICINE AND SURGERY PLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PODIATRIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | HOLT |
Authorized Official - Last Name: | ALLEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 480-633-7944 |
Mailing Address - Street 1: | PO BOX 9058 |
Mailing Address - Street 2: | |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85214-9058 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-609-9300 |
Mailing Address - Fax: | 480-609-9350 |
Practice Address - Street 1: | 2919 S ELLSWORTH RD |
Practice Address - Street 2: | SUITE 124 |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85212-2167 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-633-7944 |
Practice Address - Fax: | 480-633-0255 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-19 |
Last Update Date: | 2023-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207Q00000X, 207QS0010X, 207R00000X, 207RS0010X, 207XX0004X, 2085R0202X, 2085R0204X, 2085U0001X, 2086S0129X, 213E00000X, 213ER0200X, 213ES0103X, 225100000X | ||
AZ | 0622 | 213EP1101X, 213EP1101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213EP1101X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | Group - Single Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RS0010X | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 213ER0200X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | Z115920 | Medicare PIN | |
AZ | V06972 | Medicare UPIN | |
5913570001 | Medicare NSC |