Provider Demographics
NPI:1487020053
Name:ACE FOOT AND ANKLE MEDICAL CLINIC
Entity Type:Organization
Organization Name:ACE FOOT AND ANKLE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-508-8653
Mailing Address - Street 1:500 E REMINGTON DR STE 29
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2612
Mailing Address - Country:US
Mailing Address - Phone:510-508-8653
Mailing Address - Fax:
Practice Address - Street 1:500 E REMINGTON DR STE 29
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2612
Practice Address - Country:US
Practice Address - Phone:510-508-8653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5230261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01345877OtherPTAN P01345877