Provider Demographics
NPI:1821618463
Name:FOOT & ANKLE SPECIALISTS OF ARIZONA PLLC
Entity Type:Organization
Organization Name:FOOT & ANKLE SPECIALISTS OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-544-9090
Mailing Address - Street 1:18301 N 79TH AVE STE F168
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6045
Mailing Address - Country:US
Mailing Address - Phone:623-544-9090
Mailing Address - Fax:623-546-3704
Practice Address - Street 1:4550 E BELL RD STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9385
Practice Address - Country:US
Practice Address - Phone:623-544-9090
Practice Address - Fax:623-546-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty