Provider Demographics
NPI:1558968750
Name:FAMILY FOOT AND ANKLE OF IDAHO L L C
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE OF IDAHO L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-996-3519
Mailing Address - Street 1:3597 E MONARCH SKY LANE
Mailing Address - Street 2:SUIT 240 PMB 2358
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1055
Mailing Address - Country:US
Mailing Address - Phone:208-996-3519
Mailing Address - Fax:208-906-2195
Practice Address - Street 1:3597 E MONARCH SKY LANE
Practice Address - Street 2:SUIT 240 PMB 2358
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1055
Practice Address - Country:US
Practice Address - Phone:208-996-3519
Practice Address - Fax:208-906-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty