Provider Demographics
NPI:1710212204
Name:FOOT AND ANKLE PROFESSIONAL CENTERS OF IOWA, PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE PROFESSIONAL CENTERS OF IOWA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:641-683-7901
Mailing Address - Street 1:520 N SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-4228
Mailing Address - Country:US
Mailing Address - Phone:641-683-7901
Mailing Address - Fax:641-682-1158
Practice Address - Street 1:520 N SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4228
Practice Address - Country:US
Practice Address - Phone:641-683-7901
Practice Address - Fax:641-682-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3115741Medicaid
6349100001Medicare NSC
U45991Medicare UPIN