Provider Demographics
NPI:1659531291
Name:FOOT AND ANKLE CARE CENTER, PA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-290-2000
Mailing Address - Street 1:225 UNIVERSITY AVE W STE 126
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-3907
Mailing Address - Country:US
Mailing Address - Phone:651-290-2000
Mailing Address - Fax:651-290-2000
Practice Address - Street 1:225 UNIVERSITY AVE W STE 126
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-3907
Practice Address - Country:US
Practice Address - Phone:651-290-2000
Practice Address - Fax:651-290-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN656261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN054942800OtherMETROPOLITAN HEALTH CARE
MN054942800Medicaid
MN423601029964OtherPREFERRED ONE
MN149R5VAOtherBLUE CROSS BLUE SHIELD PIN#
MN167471OtherUCARE
MN141291OtherUCARE PIN #
MN149R4FOOtherBLUE CROSS BLUE SHIELD
MN79140OtherHEALTH PARTNERS
MN1029964OtherPREFERRED ONE PIN #
MN2700242OtherMEDICA
MN167471OtherUCARE
MN480000400Medicare PIN