Provider Demographics
NPI:1578569646
Name:MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FOOT AND ANKLE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:BOWEN
Authorized Official - Last Name:HENINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-881-4494
Mailing Address - Street 1:PO BOX 540610
Mailing Address - Street 2:
Mailing Address - City:N SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0610
Mailing Address - Country:US
Mailing Address - Phone:801-505-0821
Mailing Address - Fax:
Practice Address - Street 1:1515 N 400 E STE 106
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-7595
Practice Address - Country:US
Practice Address - Phone:435-514-1312
Practice Address - Fax:435-514-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53361970501213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID7627130003OtherMEDICARE NSC