Provider Demographics
NPI:1659527893
Name:THE FOOT & ANKLE INSTITUTE LLC
Entity Type:Organization
Organization Name:THE FOOT & ANKLE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-2671
Mailing Address - Street 1:340 FALCON RIDGE PKWY
Mailing Address - Street 2:BUILDING 300, SUITE A
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8850
Mailing Address - Country:US
Mailing Address - Phone:702-346-7678
Mailing Address - Fax:702-346-1623
Practice Address - Street 1:340 FALCON RIDGE PKWY
Practice Address - Street 2:BUILDING 300, SUITE A
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8850
Practice Address - Country:US
Practice Address - Phone:702-346-7678
Practice Address - Fax:702-346-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78902GR213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV2504OtherBCBS FEDERAL
NV100506164Medicaid
NVV40074Medicare PIN
NV100506164Medicaid