Provider Demographics
NPI:1851540520
Name:TIMPANOGOS FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:TIMPANOGOS FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-671-4726
Mailing Address - Street 1:150 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1648
Mailing Address - Country:US
Mailing Address - Phone:435-671-4726
Mailing Address - Fax:435-654-4026
Practice Address - Street 1:150 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1648
Practice Address - Country:US
Practice Address - Phone:435-671-4726
Practice Address - Fax:435-654-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6672822-0501261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6212000001Medicare NSC