Provider Demographics
NPI:1871678979
Name:SOUTHWEST FOOT INSTITUTE INC
Entity Type:Organization
Organization Name:SOUTHWEST FOOT INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-340-8686
Mailing Address - Street 1:926 E MCDOWELL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2503
Mailing Address - Country:US
Mailing Address - Phone:602-340-8686
Mailing Address - Fax:602-340-8061
Practice Address - Street 1:926 E MCDOWELL RD
Practice Address - Street 2:SUITE 121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2503
Practice Address - Country:US
Practice Address - Phone:602-340-8686
Practice Address - Fax:602-340-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ0154213EP1101X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ700379001Medicaid
AZZWCHTFOtherGROUP MEDICARE NUMBER
AZZWCHTFOtherGROUP MEDICARE NUMBER
AZ0834030001Medicare NSC