Provider Demographics
NPI:1699367094
Name:STEP AHEAD FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:STEP AHEAD FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-308-4557
Mailing Address - Street 1:26 SHADED ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5118
Mailing Address - Country:US
Mailing Address - Phone:208-308-4557
Mailing Address - Fax:
Practice Address - Street 1:40 FOUR MILE DR STE 8
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2655
Practice Address - Country:US
Practice Address - Phone:406-755-2818
Practice Address - Fax:406-755-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty