Provider Demographics
NPI:1821492018
Name:ARCHES FAMILY FOOT CARE LLC
Entity Type:Organization
Organization Name:ARCHES FAMILY FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-506-8839
Mailing Address - Street 1:65 EAST 100 NORTH
Mailing Address - Street 2:PO BOX 702
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0702
Mailing Address - Country:US
Mailing Address - Phone:435-528-2130
Mailing Address - Fax:435-528-2186
Practice Address - Street 1:65 EAST 100 NORTH
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634-0702
Practice Address - Country:US
Practice Address - Phone:435-528-2130
Practice Address - Fax:435-528-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9114085-0501213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty