Provider Demographics
NPI:1689842759
Name:AMES FOOT CLINIC PC
Entity Type:Organization
Organization Name:AMES FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-663-0900
Mailing Address - Street 1:2222 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8700
Mailing Address - Country:US
Mailing Address - Phone:515-663-0900
Mailing Address - Fax:515-663-0905
Practice Address - Street 1:2222 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8700
Practice Address - Country:US
Practice Address - Phone:515-663-0900
Practice Address - Fax:515-663-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00623213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21072OtherWELLMARK
IA2148494Medicaid
IA6329420001Medicare NSC
IAI11152Medicare PIN