Provider Demographics
NPI:1508994955
Name:FOOT & ANKLE CLINICS OF UTAH, P.C.
Entity Type:Organization
Organization Name:FOOT & ANKLE CLINICS OF UTAH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-631-9035
Mailing Address - Street 1:504 E 770 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4101
Mailing Address - Country:US
Mailing Address - Phone:801-765-1718
Mailing Address - Fax:801-224-2195
Practice Address - Street 1:504 E 770 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4101
Practice Address - Country:US
Practice Address - Phone:801-765-1718
Practice Address - Fax:801-224-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103460-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid
UT000058191Medicare ID - Type Unspecified