Provider Demographics
NPI:1639291776
Name:COMPREHENSIVE FOOT & ANKLE, SC
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT & ANKLE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-265-5225
Mailing Address - Street 1:201 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-8835
Mailing Address - Country:US
Mailing Address - Phone:715-634-9023
Mailing Address - Fax:715-634-9935
Practice Address - Street 1:201 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8835
Practice Address - Country:US
Practice Address - Phone:715-634-9023
Practice Address - Fax:715-634-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-07-21
Deactivation Date:2009-10-27
Deactivation Code:
Reactivation Date:2010-06-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43269400Medicaid
CG4176OtherRAILROAD MC
WI000080300Medicare PIN
WI43269400Medicaid