Provider Demographics
NPI:1538282116
Name:IDAHO FOOT & ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:IDAHO FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:EMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-327-0627
Mailing Address - Street 1:809 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8703
Mailing Address - Country:US
Mailing Address - Phone:208-327-0627
Mailing Address - Fax:208-376-5258
Practice Address - Street 1:809 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8703
Practice Address - Country:US
Practice Address - Phone:208-327-0627
Practice Address - Fax:208-376-5258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001970800Medicaid
ID004395700Medicaid
ID805793600Medicaid
ID002680100Medicaid
ID002680000Medicaid
IDU50424Medicare UPIN
IDT84786Medicare UPIN
ID1350975Medicare ID - Type UnspecifiedMEDICARE
ID002680000Medicaid
ID001970800Medicaid
ID1350655Medicare ID - Type UnspecifiedMEDICARE
ID805793600Medicaid
ID1350764Medicare ID - Type UnspecifiedMEDICARE
ID004395700Medicaid
ID002680100Medicaid