Provider Demographics
NPI:1790183028
Name:WEILAND FOOT AND ANKLE CLINIC, PROF. L.L.C.
Entity Type:Organization
Organization Name:WEILAND FOOT AND ANKLE CLINIC, PROF. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:605-212-5941
Mailing Address - Street 1:24237 474TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-6120
Mailing Address - Country:US
Mailing Address - Phone:605-212-5941
Mailing Address - Fax:605-205-7612
Practice Address - Street 1:24237 474TH AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-6120
Practice Address - Country:US
Practice Address - Phone:605-212-5941
Practice Address - Fax:605-205-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD179213E00000X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDV03578Medicare UPIN